How to Treat Alar Retraction?

I've always been very self concious of my retracted nostrils. I hate the columella show- especially from the right side! Also, I hate how large/flared the nostrils look from the frontal view (like a "V"). In what way is this normally treated? It is possible to have the surgery under local?

Doctor Answers 11

You may consider a Non-Surgical Rhinoplasty to improve your alar retraction.

You would be surprised how much improvement you could see with a Non-Surgical Rhinoplasty procedure. I have had wonderful success lowering nostril margins with Silikon-1000 for permanent results. Several treatments are typical for a desired result. You should consult a specialist experienced in this technique. Procedures are performed with topical anesthetic, and there is typically no downtime.

If any of my colleagues wish to learn more about my experience with Silikon-1000, I am giving an instructional course at the upcoming Fall Meeting of The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). The course is titled "Off-Label Applications of Liquid Injectable Silicone (LIS)", and I will be presenting on 9/24/2010 at 4pm. Common conditions treated with LIS include: volume replacement, wrinkle reduction, lip enhancement, acne scarring, and correction of many nasal irregularities (“Non-Surgical Rhinoplasty”). I will also be describing the serial puncture, microdroplet technique that is essential for achieving desired results and minimizing complications.

I hope this is helpful for you.

West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

Cartilage grafting for alar retraction

Alar retraction is one of the potential consequences of rhinoplasty - most common with the older closed rhinoplasty techniques when the surgeon can't see exactly how much cartilage they are leaving behind.  It can be improved/corrected with cartilage grafting.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Alar Retraction Rhinoplasty surgery

Retracted nostrils or ala treatment varies on the exact cause of the nasal retraction. Typically, cartilage grafts (ear or septum) are placed in the nostril rims. Alternatively, if there is nostril scarring, small skin grafts are placed inside the nose to push down the retracted nostrils.

Another factor is the columella, which could be hanging or excess which contribute to the appearance of retracted ala. The columella can be set back, by either adjusting skin, cartilage, or bone accordingly.

Only after a comprehensive evaluation by a rhinoplasty surgeon can he/she advise you on an appropriate treatment option. Best of luck.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Treating Alar Retraction with Composite Grafts

Alar retraction is quite a tricky problem in secondary rhinoplasty.  The first thing to do is to make a diagnosis as to why the alar retraction exists.  The reasons include alar malposition, over resection of the lateral crura, mucosal scarring with retraction, columellar excess, as well as facial structural problems such as vertical maxillary excess.  Once the diagnosis is made, then the plan for treatment can be made.  Depending on how much retraction there is, the treatment could range from lateral crural strut grafts, with or without alar repositioning, to rim grafts, to composite grafts.  Every case is different so each problem must be treated individually.

Jay Calvert, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 50 reviews

Treatment options for alar retraction


Alar retraction can be treated several different ways.  Traditional alar retraction is treated with composite grafts of skin and cartilage taken from the ear and then sewn in on the inside of the alar and nostril rim to bring the rim margin downward.  Relative alar retraction can be addressed through trimming the caudal and membranous septum so that the columella does not hang down.  If the alar retraction is caused from columellar show, simply trimming the columella back will achieve that goal.  Alar rim grafts are also helpful when there is alar notching.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Retracted ala need to be pushed down

This is one of the trickier problems to fix in rhinoplasty. With alar retraction, there is a deficiency of soft tissue which cause the nostril margins to be too high. To create a small degree of lowering of the ala (1-2mm), small cartilage grafts can be inserted within the soft tissue of the ala. These alar rim grafts also provide benefit by strengthening the nostril margin.

For more than 2mm of reduction, some additional skin needs to be added to further push the alar margin down. Just a skin graft is too flimsy to accomplish this. So a graft in which skin and cartilage is incorporated together taken from the ear (a composite graft) is inserted into an incision on the inner aspect of the nostril margin. This allows for significant (up to 3-4 mm) lowering of the ala.

David W. Kim, MD
Bay Area Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

Retracted Nostril

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

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 51 reviews

That depends on why you have alar retraction....

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.

Ivan Wayne, MD
Oklahoma City Facial Plastic Surgeon
5.0 out of 5 stars 61 reviews

Treating Alar Retraction

You raise many questions. Your columella can be raised by removing a piece of catilage from the septum immediately above the columella. Removal of a small amount of cartilage from the columella can be helpful if there is excessive convexity of  your columella. A cartilage or cartilage and skin graft will lower the nostril rim if there is alar retration. Removal of tissue at the alar base (at the junction of the ala and the upper lip) will decrease nostril flaring. If you submit a photo, we can be more specific.  

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Rhinoplasty Required to Treat Alar Retraction

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

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 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.