How to Treat Alar Retraction?

Alar retraction can be due to weak or vertically angled cartilages of the tip. It can also be an illusion caused by drooping of the columella (the skin separating the 2 nostrils at the base of the nose). Columellar 'show' or drooping can be from weak tip cartilages or an overgrown septum.
Obviously, the issue can be quite complex. The correct solution to your problem depends on your anatomy. It can involve any combination of shaving the septum, adding cartilage grafts (alar rim grafts) to the nostril edge, or grafting to the columella to provide strength and tip elevation.
This is an issue that requires an examination by an experienced nasal surgeon.
Best of luck

That question is hard to answer without seeing photos of you and knowing your medical history. If you have had a prior rhinoplasty most likely you will need revision work and treatment of the underlying problem with cartilage grafts and correction of tip projection issues.
If you have never had surgery before then you will probably need some form of grafting to bring down the sidewalls. It could be done under local but that would be challenging. If you post photos of your nose and give us some additional information we could answer your question more accurately. Hope this helps.

Hi Freiheit in Washington, DC,
A surgical rhinoplasty with an experienced surgeon will help you achieve the nose appearance that you desire. Your nose will be evaluated, a diagnosis made, and then an appropiate surgical plan to correct your nose.
Although the surgery can be performed under local anesthesia, most patients and surgeons prefer having an anesthesiologist present.
Do choose your rhinoplasty surgeon most carefully.
Good luck and be well.
Dr. P