The lateral crural extension graft is a simple and reliable method for correcting alar rim retraction. In cases of severe skin deficiency, it is not sufficient and a composite graft reconstruction must be used.
The cause of alar retraction after rhinoplasty is often the weakening of the lower lateral cartilages which are the cartilages that are in the tip and go out toward the side wall of the nostril where it meets the cheek.
The rate of alar retractions can be reduced by avoiding significant alar cartilage and alar vestibular excisions and by reinforcing the alar rim after rhinoplasty surgery. When alar notching presents in patients, cartilage grafting can be used to lower the alar rim to a more ideal position.
Alar Margin (Rim) Graft
Alar rim grafts are nonanatomic cartilage grafts used to provide structural support to the alar margin. They can be used to straighten alar notching, treat mild alar retraction by pushing the alar margin down 1 to 2 mm, or prophylax against alar retraction in at-risk primary or revision cases.
Alar Notching
Notching is common in patients who have had a rhinoplasty. This is because when the tip was made smaller, the alae retracted upward. This is why it is important for the surgeon to take steps during the rhinoplasty to make sure notching does not occur.
To adequately address this issue the cartilages need to be reinforced with cartilage grafts. Revision rhinoplasty for retracted nostrils demands meticulous surgical precision. The procedure typically involves the careful harvest and transplantation of cartilage grafts to bolster the weakened nasal rim.
Eyelid retraction can lead to lagophthalmos and exposure keratitis, which can cause mild ocular surface irritation to vision-threatening corneal decompensation. The most common causes of upper eyelid retraction include thyroid eye disease, recession of superior rectus muscle, and contralateral ptosis.
Methods to decrease projection
High partial or full transfixion incision. Lateral crural overlay (also increases rotation) Nasal spine reduction. Vertical dome division with excision of excess medial crura with suture reapproximation.
The tip of your nose—whether it is droopy, pointed or upturned—is formed from soft cartilage. It isn't possible to alter the bone and cartilage without surgical intervention, but all hope is not lost yet. The muscles around the nose can be stimulated and toned with regular exercise.
Alar base reduction produces permanent results and cannot be reversed. If you are unhappy with the appearance of your alar base reduction performed elsewhere, revision surgery may be considered to correct the appearance.
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