Small Skin Grafts for Alar Retraction?

Hi,I have undergone revision rhino 3 months ago.I'm very happy with everything except for minor 1side alar retraction(photo). It is not structural, and I am sure it is from scarring. When I look at it in mirror it doesnt look bad, but in photos its very obvious. I read one doctor saying that "Alternatively, if there is nostril scarring, small skin grafts are placed inside the nose to push down the retracted nostrils."Can I have some more info on this procedure please?Can local freezing be used?

Doctor Answers 8

Correcting asymmetric nostrils after rhinoplasty

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Lowering a nostril which is retracted can be done quite easily and predictably with the placement of a composite graft or a small cartilage graft, such as a rim graft. The composite graft consists of skin and cartilage and is usually harvested from the ear. The rim graft can be taken from the ear or septum and placed in a small pocket along the inside of the nostril. In both cases, the procedure can be comfortably performed in 30-45 minutes under local anesthesia, with or without mild sedation. 

Best of luck.

Dr. Mehta

Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Composite grafts or rim grafts to correct alar retraction in rhinoplasty

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Local anesthesia can be used for the procedure to correct the alar retraction.  Cartilage is necessary to push the retracted nostril down, in the form of a rim graft, or cartilage + skin in the form of a composite graft.  A composite graft is a small, fusiform shaped piece of skin and cartilage that is taken from the mid-portion of your ear (concha).  Once healed, you shouldn't notice a change to the shape or appearance of your ear donor site.  A small incision is then made inside your nostril, and the skin of the composite graft sutured to it.  The graft stays swollen for several months, but as the swelling resolves the nostril is slowly "pushed" down.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 reviews

How to correct alar retraction

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There are several approaches to correcting alar retraction.

  1. For mild cases, placement of a rim graft can help lower the alar margin.
  2. In more significant cases, I have found very good success using a lower lateral cartilage repositioning maneuver. This involves freeing up the cartilage that makes up the tip on that side and moving it down somewhat so that it brings the alar margin down. Pretty significant retractions can be treated using this technique. Additional cartilage (septal cartilage or rib if not enough septal cartilage is available) is grafted at the time to help strengthen the tip and prevent further retraction.
  3. Composite grafting involves placing ear cartilage with some skin attached as a graft on in the inside of the nostril. I have found that this can lead to an unnatural eversion of the nostril margin, however, so I prefer using the LLC repositioning technique discussed above.

I would wait at least a year before considering revision surgery, however, You're early in the course of healing and the nose will continue to evolve. It's even more difficult to bring the nostril margin down if it's still firm with scar that hasn't softened yet.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Options for mild alar retraction

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You should at least wait 6-8 months - grafting of the rim (either cartilage or skin+cartilage) can be done internally with local or light IV sedation

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Correction of Alar Retraction following Rhinoplasty

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I can appreciate your concerns about the alar retraction present on the right.  At this time, I would wait until the "shrink wrap effects" of scar tissue formation under the nasal skin and soft tissue have fully matured, about one year postoperatively.  If this retraction is still present or worsened, it can easily be fixed with cartilage grafting.  For small amounts of alar retraction, rim grafts can be placed in precise pockets under the nasal skin to lower the nostril.  If larger amounts of retraction are present, composite grafts consisting of skin/soft tissue/cartilage can be harvested inconspicuously from the ear to correct retraction.  Good Luck.....Dr. Corrado

Anthony Corrado, DO
Philadelphia Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Alar Retraction

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Your alar retraction can be corrected by using a small cartilage graft or a composite graft of cartilage and skin to lower the nostril margin. Carttilage and/or skin are harvested from the ear. I strongly suggest you wait 6-9 months.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Grafts and Alar Retraction

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Alar retraction can be corrected using composite grafts place in the area of retraction. The composite graft comprise of skin, cartilage and soft tissue usually harvested from the ear. You may also require some tip work as well.



Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 reviews

Your retracted nostril may be improved by a Non-Surgical Rhinoplasty procedure.

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I read your concern and reviewed your photo. If your retracted right nostril is your only concern after revision rhinoplasty surgery, this may be improved by a well-performed Injectable Filler procedure. My personal experience is with Silikon-1000 for permanent results. I've attached a photo from my RealSelf gallery demonstrating nostril lowering after previous rhinoplasty surgery. I hope this is helpful for you.

Regards from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 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.