Bridge and nostrils are crooked after septoplasty - do I need an alar reduction? (photos)

Question

I had a septoplasty done many years ago. Since then, my bridge and nostrils are crooked. My nostrils are also high - the lower part of my crooked septum is exposed. Would this procedure be alar reduction? I am reading that is a more difficult surgery, is that correct?

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. Based on the photos you provided, your concern is not an alar reduction but a correction of your septum, which appears to be crooked. I highly recommend consulting with a reputable board-certified facial plastic surgeon, particularly one with a strong rhinoplasty portfolio and extensive experience with septoplasty. During your consultation, your surgeon can do a proper evaluation of your nose, determine your eligibility for a revision procedure, and recommend the best approach to ensure the best possible outcome.

Jeffrey Lisiecki, MD · Answer

Septoplasty alone can help alleviate a breathing problem, but often doesn't give the ability to truly fix the problem. Your septum is still significantly deviated (that's what you see looking up your left nostril). A deviated septum can certainly lead to a deviated nose (though based on your pictures it is hard to assess your nasal deviation). You also have alar rim retraction, as you have noticed! The fix for all of these concerns is a rhinoplasty with septal reconstruction and alar rim contour grafts. You should be seen in person by a plastic surgeon to be evaluated and discuss your concerns.

Andrew Miller, MD · Answer

Your photo shows primarily the septum on the left is still crooked. The nostrils themselves are pretty even and don't really need any work. You have a small bump and the tip is a bit boxy, so those things could be done during rhinoplasty. Be sure to see a rhinoplasty specialist for consultation.

John Michael Thomassen, MD · Answer

Your caudal septum is off to the side and this needs to be repositioned to the midline.  An alar resection will not correct this.  Also an alar rim cartilage graft should be placed to correct the slight alar notch.  A slight dorsal hump reduction can also be done if you like to improve the final shape.

Marc Polacco, MD · Answer

Thank you for your question. Your concerns are most likely concerning the septum showing on the left, as well as what we refer to as "columellar show". Addressing this is actually more involved than alar reduction, and given that you've had a septoplasty, it would be best if you seek out a surgeon who specializes in surgery on the nose and revisions to optimize your chances of a successful outcome. I hope this is helpful, and I wish you all the best.
-Dr. P

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! After septoplasty, it is possible that the remaining portion of cartilage has "spring" or "memory" to it causing the shape of your tip and nostrils to change. If that's the case, a revision procedure may be needed to restructure the cartilage, giving your tip the best chance for symmetry. Based on the photos, it's hard to tell if the caudal septum is the problem area, but it may be. I would not suggest alar base reduction. Seek consultation with a facial plastic surgeon who is also ENT trained to see what the best option is. Hope this helps!

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