The Alar Rim
The nostrils have a floor (sill) and roof (alar rim). The alar rims surround the nostril aperture (entry to the nose) and can be retracted or hanging like the columella. In addition, they can be wide or flared at their junction where they meet the cheek and upper lip skin. Retracted alar rims can exist naturally or be a result of a rhinoplasty. To correct them in each situation, the same steps are often necessary: lowering and strengthening them requires grafts and struts to be placed. The alar rims are very sensitive to retraction when excessive tip raising or shaping is performed. Also, if a nose surgery patient has tip cartilage that is oriented in the wrong angle (whether from surgery or from birth), then there is a higher chance for alar retraction (nostril rim pulling) and breathing problems. In this case, grafts must be placed during a rhinoplasty and/or cartilage repositioned to prevent future problems with retraction and nostril (alar) rim weakness.
Dr. Ghavami has a systematic approach to alar rim issues that can involve strut grafts, repositioning of the alar cartilages, or both , depending on the circumstance.
It is common to have alar rim problems after an undesirable rhinoplasty. Dr. Ghavami’s revision rhinoplasty usually involves supporting and reshaping of the alar rims. He will consult with you and draw out the plan to address any issues with your nose post-rhinoplasty so that the goals for your revision rhinoplasty are clear and well communicated.