Will composite ear graft to bring down the alar rim give me an aesthetically pleasing result?

Of course there's the caveat that I haven't had the chance to examine you in person, but... in my experience, a composite graft to lower a nostril edge is used when the edge needs to come down *a lot*, and I don't see your nose that way. It's also technically very difficult, and sometimes only works a little bit. And somehow, the lower part of your nose looks strong-ish to me, and I don't want to see anything to make it, or any piece of it, stronger or longer. *Some* columellar show is normal; if you want to see just a little bit less, there are other ways to approach it that can make a small change with much less work and risk.
I don't know. I'd just say don't necessarily jump into it--get another couple of opinions for sure. There are probably only a very small percentage of rhinoplasty surgeons who can get that procedure done with high skill.

In our practice, Revision rhinoplasty is left as a last resort. Depending on your examination, Microdroplet Silikon-1000 may be considered for lowering your nostril margins and for achieving nostril symmetry. Hope this helps. Dr Joseph

The photos you have provided are helpful. Composite ear graft is a good way to bring down a severely retracted nasal alar rim. When I see your photos I see two issues. One is that the rim is slightly retracted and the other is that you have a bit of tip over rotation with a hanging columella. Not certain that just addressing the alar margins will take care of this. As an aside, there is usually always something that can be done to improve the appearance of a nose. Your nose is not unattractive so I would be cautious in submitting to a third rhinoplasty.

It's understandable that you want to ensure that you will be left with an aesthetically pleasing result after your third revision rhinoplasty. The use of composite ear grafts to bring down the alar rim can be a good option for correcting nostril show without reducing the base of the nose. However, the success of the procedure will depend on several factors, including the skill and experience of the surgeon, the condition of your nose, and your individual goals and expectations.

It's always a good idea to get a second opinion from another qualified plastic surgeon before undergoing any surgery. This can help you get a different perspective on your options and ensure that you are making an informed decision.

When consulting with a second surgeon, be sure to provide a full history of your previous rhinoplasty procedures, including any complications or issues you have experienced. You should also bring any photos or notes that you have from previous consultations or surgeries.

During the consultation, the surgeon will examine your nose, assess the condition of the skin and cartilage, and discuss your goals and expectations for the procedure. They may recommend alternative techniques or procedures based on your specific needs and anatomy.

Overall, the use of composite ear grafts can be an effective way to correct nostril show without reducing the base of the nose, but it's important to consult with an experienced and qualified plastic surgeon to ensure that it is the right option for you.

Best of luck !

From these photographs, the alar retraction on your left side is minimal. You have an overly rotated, overly projected nose with a hanging columella. Consider a revision and rhinoplasty to reduce the over projection of your nose, reduce the hanging columella and de-rotate your nose. Once those maneuvers are performed, a composite graft may be performed once that hanging columella is addressed. You also have a recessive chin profile which makes your nose look over projected. Also consider placement of a small chin implant as a separate procedure or in combination with the revision rhinoplasty