I'm 1 year post-op - Would lowering my nostrils with filler be better than revision rhinoplasty or an alarplasty? (photos)

Question

I’m 1 year post op and my surgeon advised filler in my nostrils to reduce the amount you can see up inside my nose. Is this a bad idea and would a revision surgery with ear cartilage or alarplasty be necessary instead?

Jason Emer, MD · Answer

Hello and thank you for your question. You have a very difficult problem to fix. It sounds like your biggest concern is your increased nostril show after your surgery. This is due to alar retraction, which can unfortunately happen as the scarring after rhinoplasty contracts the nasal alae vertically, as in your case. There are certain maneuvers which can be performed during rhinoplasty surgery to prevent such retraction. Given you've previously had a rhinoplasty, and there is no doubt extensive scar tissue present in your tip and alae, fillers would not be able to overcome the scarring, and only an open rhinoplasty can best address your issue.

In addition to addressing your aesthetic concerns, your septal cartilage (or an off-the-shelf alternative) would be harvested (removed) and turned into multiple cartilage grafts, which would then be secured into different areas of your nose for structural support, including in the columella (middle bottom portion of your nose between your nostrils) to really reinforce the tip and alae, and prevent recurrence of the alar retraction. As you've already had a rhinoplasty, likely your septal cartilage has been used already, so we'd use an off the shelf alternative (MTF cartilage)- ear cartilage is too weak to address your issue, and alarplasty alone without reinforcing the structure wouldn't fix the problem.

The open approach is very effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery. I would only recommend going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible.

Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos and description provided.

Dr. Donald Groves, our expert facial plastic surgeon, has extensive training and experience with complex rhinoplasty surgeries, so I’d recommend for you to come see him (or another plastic surgeon who is extremely comfortable with rhinoplasties) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Emer

Eric M. Joseph, MD · Answer

We have had excellent success lowering retracted nostril margins with microdroplet Silikon-1000 nasal treatments. An examination would be necessary to determine the feasibility for most people. Hope this helps. Dr Joseph

Nelson Lee Novick, MD · Answer

The use of filler in the wings of the nose, particularly a nose whose internal vascular anatomy may have been altered by prior surgery, should be left to the hands of a very experienced physician injector. To assess whether the cosmetic result of injecting the nostrils would result in satisfying improvement, the injecting physician can inject salt solution of diluted anesthetic solution as "test trial" the into the alar portion of the nostrils. If sufficient and gratifying improvement is obtained, then an appropriate HA filler can then be injected. Make sure that you consult with an experienced, board certified cosmetic dermatologist. Hope this helps.

I'm 1 year post-op - Would lowering my nostrils with filler be better than revision rhinoplasty or an alarplasty? (photos)

Answers (3)

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