What Can I Do About Right Alar Notch?

I had a revision rhinoplasty about ten weeks ago. The only problem is my nostrils are very uneven. The right nostril is very notched and arched giving me a snarl look. I really don't like it and would like to know if there is anything that can be done? I know that it is still too early and I have to wait for my nose to completely heal. I also do not want another open rhinoplasty. Thanks

Doctor Answers 4

Right Alar Notch After Rhinoplasty

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Yes, it is too early to even make any final assessments.  However, after another 8 weeks or so, you can begin to investigate some type of alar sculpting procedure, of which there are several types to achieve different goals.  I'd be happy to review your photos and provide you with my recommendations.

Miami Facial Plastic Surgeon
4.7 out of 5 stars 145 reviews

Treatment of Alar Notch

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Wait another 6-8 months before placing a small cartilage graft at the alar rim to correct the contour of the nostril rim. This can be done under local anesthesia with a small incision inside the nostril.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Correction of an Alar Notch or Retraction

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Thanks for the question. There are three commonly used maneuvers for correction of alar notching, all of which can generally be done through a closed or endonasal rhinoplasty approach.  

For mild notching or retraction, a rim graft can be placed. This is a thin sliver of cartilage which is placed along the rim of the nostril through a tiny incision made just inside the nostril. This can be done without any external visible incisions. The cartilage can be taken from the septum or from the ear.

For more severe cases, a composite graft (ear cartilage with attached skin) can be used. The composite graft is flipped inside the nose such that the small bit of skin from the ear is used to reconstruct the inner lining of the nostril. 

If the alar notching is accompanied by pinching or collapse on the sides of the tip, this may be an indication that the underlying tip cartilages are too weak and flimsy to support the nostrils. In these cases, a lateral crural strut graft may be needed to strengthen or reconstruct the tip cartilage on the affected side. Either an open or endonasal approach may be appropriate for this maneuver. 

I would recommend that besides your initial surgeon, you also you seek consultations with a few other revision rhinoplasty surgeons to make sure you find a physician with whom you feel comfortable and understand the surgical plan and goals. 

Best regards,

Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Notched nostril

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Notched nostril will require a cartilage graft to correct.

Wait atleast 6 months then reevaluate the nose and a decision as to what needs to be done.

Samir Shureih, MD
Baltimore Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.