LAM FACIAL PLASTICS

Hi Dr Lim,

I am a white male who underwent a primary several years ago to straighten my nose and slightly deproject the tip. While the surgeon was successful in doing each of those things, the surgery resulted in several irregularities and asymmetries.

One of the asymmetries was my nostrils, where one was noticeable higher than the other. The surgeon used alar rim grafts on both sides to improve the symmetry.

Of course, while the symmetry was improved, the result was also an increase in the flaring and perceived width of my nostrils post-revision. To the point where pictures of my nose from the front look very bad (the profile looks fine).

This is getting very frustrating, every time something is corrected one or two more problems arise. The surgeon simply says he has achieved a "good result" and nothing else can be done.

I did seek a second opinion and the second doctor said I "may benefit' from an alar base reduction.

My question to you is, can an alar base reduction be performed after alar rim grafts have been used? I am 100% sure that if my nostrils were slightly narrowed and less flared that I would finally be content with the outcome. But I'm very concerned that it could just lead to new problems.

I can try and send you pics, but in the meantime do you have any advice for me?

you should be fine with alar rim grafts in general if the ala are reduced. i doubt the surgeon put it right under the skin where the reduction would be. it wouldn't make sense. when i deproject a nose, i sometimes also have to take care of the resulting flare either at the same time as the procedure or down the road when i see where the nasal tip finally settles.

alar base reductions are tricky too since this is the one area where scars do not heal perfectly on a consistent basis. sometimes from a side view you can see a little bit of scarring. if you are white (i.e., not dark skinned hispanic, asian, or african), then you can undergo dermabrasion several months later to refine the scar but it won't be gone. you have to know that before signing up. in addition, it is important that whatever surgeon who does it for you perform a Sheen style flap that preserves the natural curvature of the ala so you don't get the Janet Jackson step off looking nose.

also, every procedure does carry some risk and no rhinoplasty procedure is ever "perfect". you must weigh the pros and cons of touching your nose again. sometimes it is worth it. sometimes it is not. those are my thoughts.

s.

Thanks so much for your response. Is a Sheen flap different than a Weir ecsision?

The idea of scarring is definitely a concern. My problem is that the excessive nostril flare introduced by the alar rim grafts are more of a concern for me than the initial asymmetry in the nostrils in the first place.

If I decide not to have the alar base reduction done (for concerns of excessive scarring, or other complications) is it possible to have someone remove the alar rim grafts? If so, would there be any lasting effect from the alar rim grafts?

Thanks!!

no, a weir is simply a wedge without preserving a flap. hate weirs.

i don't know exactly how the alar rim grafts were placed but most likely they are not easy to remove unless you open the entire nose, at least in my hands. cartilage grafts become quite tenacious over time to remove easily.