Lowering the alar rim to correct alar retraction / nostril show? (Photo)

Surgeon said that I had alar hooding / overhanging alars so he trimmed the overhanging portion along the alar rim. Supposedly this was to bring the alar and columella into a better alignment. However, I feel my alars were not THAT overhanging and now this has caused my alar rims to look too retracted upwards and exposes too much nostril. Is a composite cartilage graft the right technique to push the alar rims back down to reduce the retraction? Essentially I want to reverse as much of this as possible.

Doctor Answers 6

composite graft for lowering alar rims

A composite graft is composed of both skin and cartilage, is harvested from inside the ear, and is used to bring down a law rim when there's alar retraction. It's very important to have realistic expectations, and the nose will not be perfect since this is a revision and their scar tissue present

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Retracted alae

Correcting a retracted alae is not easy to do and not always successful.  Your retraction is really quite minimal and I would advise against do anything at all.  Any attempt to improve is could actually make it worse.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 24 reviews

An Alar Rim Graft is Effective to Correct Notching of the Alar Rim

Actually, where your nostril attaches to your face looks pretty good now.  The problem is that you have developed a notch in front of the area that was lifted. An alar rim graft, using a small piece of cartilage, would help smooth the notching and make things look better.  I would not try and reverse what was done, but rather improve the area right in front of it.  Good luck.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

Repairing Alar Retraction

Although there are several options for repairing alar retraction, I do not believe the portion that should be lowered is the area that you have highlighted.  Alar retraction refers mainly to the central portion of the alar rim and could be corrected by an alar rim graft.  The area you have highlighted refers to the outer alar base and appears to be in good alignment.  I would add a non-anatomic alar rim graft to lower the alar "notching" that has occurred.

Lowering the alar rims with composite graft

A composite graft would be the only reasonable method to attempt to bring the alar rims down. This will attempt to restore the tissue that was previously removed. Make sure you go to a rhinoplasty specialist for this. 

Michael T. Somenek, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Alar rim retraction

I'm sorry that you are having concerns about your surgery.  Rhinoplasty is a procedure that has a 10% revision rate generally, so don,t be too upset if you need a small revision.  Talk to your surgeon.  I am sure he/she wants you to be satisfied with the result.

I would not recommend any revision within 6 months of the surgery since swelling will continue to resolve and the small retraction of the rims may improve.  A composite graft would not make sense to correct the small amount of retraction you see.  I would consider a small alar rim graft from septal cartilage.  Again, diagnosing and recommending treatment from a surgeon who did not do the first procedure, has never examined you , and only has a few photos is always difficult and you should follow the recommendations of your surgeon.  I can say, however, that chasing small improvements too soon is the number one cause of bad results in my opinion. 

Edward J. Ricciardelli, MD
Wilmington Plastic Surgeon
5.0 out of 5 stars 24 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.