20 years post op and considering a revision - is my alar retraction fixable? (photos)

Thank you for your question and photos. It is possible to address your alar retraction during revision rhinoplasty. Your nostrils can also be narrowed and their shape redefined for a symmetrical result that complements the rest of your facial features.

Though your initial surgery was 20 years ago, it’s still important to note that each subsequent nose surgery becomes more complex due to the loss of structural support, scar tissue, and other factors. The requirement of experience, expertise, and artistry cannot be overstated. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon, with expertise in rhinoplasty techniques. They will be able to review your surgical history and assess your concerns to determine the best approach.

Based on your photos, you appear to have post-surgical nostril retraction worse on your left side compared to your right. Depending on your condition, microdroplet Silikon-1000 injections may be considered for nostril lowering on both sides to decrease your amount of nostril show and to improve nostril symmetry. I hope this is helpful! Sincerely, Dr Joseph

Alar retraction can be difficult to improve, but actually, what catches my eye is that the tip of your nose is still wide-ish, and it sits low, making the nose look long, especially on that first photo you posted, the three-quarters view.
If the tip is narrowed and elevated, that gives an additional technique through which to lessen the alar retraction, and even if the alar retraction correction is minor, if the nose looks smaller, and perhaps better to you, the remaining retraction is likely to bother you much less.
How *much* to elevate the tip, or narrow the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs -- the tip work, and any work on a nose with a previous rhinoplasty -- require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.