Had hanging alar fixed, but now my nostrils show too much. Is there a way to isolate the nostrils and repair with rim grafts?

i had a hanging alar before and now it has been fixed. i like the new position of my alars compared ot my columnellar, it was an improvement but now my nostrils look a little notched and i can now see too much of my nostrils. is there anyway to keep the alar and columnella in place but just isolating the nostrils and putting rim grafts there without touching anything else

Doctor Answers 12

Isolating Nostrils

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Dear 647461anon,

Yes, it is entirely possible to isolate the nostrils and insert either rim grafts or unfurl the nostril skin to lessen notching.

Notched ala

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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.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 31 reviews

Rim grafts may be okay, but have you considered non-surgical revision rhinoplasty?

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Dear 647461anon;

Sometimes, 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.

If you 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 like.

Best regards,

Robert Kotler, MD, FACS

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 90 reviews

Had hanging alar fixed, but now my nostrils show too much. Is there a way to isolate the nostrils and repair with rim grafts?

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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

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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.

Gilbert Lee, MD
San Diego Plastic Surgeon
4.6 out of 5 stars 25 reviews

Alar Notching

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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. 

J. Kevin Duplechain, MD, FACS
Lafayette Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Rhinoplasty revision

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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. 

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 18 reviews

Alar rim grafts?

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It is impossible to say if this is the answer for your problem without seeing photos.     

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Alar show versus hanging columella

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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

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Fixing Nostril Shape and Size.

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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.

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 52 reviews

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.