it is entirely possible to isolate the nostrils and insert either rim grafts or
unfurl the nostril skin to lessen notching.
It would really help to see photos. Cartilage grafts to the alar rims is a tricky procedure and may not necessarily deal with the problem. Are you having any breathing issues? Please resubmit with photos is you can.
Rim grafts may be okay, but have you considered non-surgical revision rhinoplasty?
things like this happen after rhinoplasty, but it is not beyond improving. You did not note how long ago you had the
surgery, and that is important because you have to wait for at least several
months before things settle down so you can see how they look. The
tissues must be soft enough to either operate upon or injected with a filler to
correct the problem.
are not aware of it, then you should do some homework on the issue of non-surgical
revision rhinoplasty.There are
temporary fillers and there are permanent fillers, and you have your choice of
several materials and techniques, and you should look into it. While the surgery may solve the problem, in
my experience, it is not necessarily the first choice.
Non-surgical rhinoplasty works because tiny drops of Silikon
1000 are injected just under the nasal skin. Over time, the body walls off
those drops with new tissue which provides the plumping action to fill in
divots or marks in the nose. The same effect can happen with plain salt water
to provide a preview how the nose will look on completion of treatment. The Kotler Saline Demo lasts perhaps two
hours, but long enough to take a photo of what the finished nose will look
Kotler, MD, FACS
Had hanging alar fixed, but now my nostrils show too much. Is there a way to isolate the nostrils and repair with rim grafts?
Yes. Retracted nostrils can be improved without affecting the tip or columella. Sometimes this can be remedied with rim grafts alone. If there is a deficit of soft tissue on the inside of the nose, occasionally composite grafts (contain both skin and cartilage) taken from the rim of the ear are required. Seek an in person consultation for more specific advice. I hope this information is helpful for you.
Stephen Weber MD, FACS
Denver Facial Plastic Surgeon
Rim grafts are an elegant way to help control notching of the ala and maintain a nice shape to the alar rim (nostril). The rim grafts can be placed by themselves without disrupting the tip and the entire nose.
Unfortunately you did not share any photos. I would recommend you visit a surgeon who offers 3D Vectra imaging to show you how your nose will look with rim grafts.
As you can see by all of the responses, photos would be the first best step to allow some basic evaluation of the problem. If alar notching is the problem that is diagnosed, then yes a composite graft from the ear is an excellent way of fixing this problem. I usually recommend nostril stents to help shape the nostril and provide some internal support to the nose, but this is not universally used.
An in-person exam is needed. However, theoretically, the alar rims can be brought down to correct notching without changing the columella or the angle. If a minor correction, an unfurling technique can be used on the rim. Otherwise a composite graft will be needed. Best wishes.
It is impossible to say if this is the answer for your problem without seeing photos.
Alar show versus hanging columella
Without pictures, it's impossible to give any opinion on what may or may not be required. A hanging columella is treated with a columellar-plasty which can improve the alar-columellar relationship. Pure notching of the nostrils is best treated with a composite graft of skin and cartilage harvested from the ear. For many examples of columellar-plasty, please see the link below
Fixing Nostril Shape and Size.
Fixing the nostril shape can be difficult. A hanging alar rim can be corrected with an alar tuck procedure. Notching can be corrected with an alar rim graft or composite graft. Nostril shape and size can be corrected with alar base excisions. The ratio of the columella to alae should be taken into account prior to any of these maneuvers.