Who is a good candidate for alar rim lowering? It depends on how the nostrils appear and what caused the alar rim to rise.

Alar rim lowering is a good fit for people whose alar rims are pulled upward, making the inside of the nostrils overly visible from the side. If the nostrils are prominent because the columella has descended, lowering the alar alone will not solve the problem. The right approach depends on how strong the upward pull is and whether the issue is cartilage weakness or insufficient skin and internal nasal tissue.

Is the nostril visibility due to the alar rim being raised?

Not necessarily, so first you need to distinguish. The relationship between the alar rim and columella in profile view has a classification, and the mismatch location is determined from the positional relationship between the alar rim edge and the nostril axis.[1].

When the alar rim rises, the appearance of the nasal tip worsens and the nostril shape becomes distorted.[2]On the other hand, if the problem is that the columella appears to have descended, surgery on the columella side rather than the alar becomes a candidate.

Can the alar rim rise even without prior nasal surgery?

It can, but most cases occur after previous nasal surgery. Alar rim elevation occurs both in people who have never had surgery and as a result of nasal surgery.[1]However, the vast majority arise after surgery.[2].

If previous surgery removed too much alar cartilage or internal nasal skin, the cartilage weakens and becomes pulled upward.[1]This can not only affect appearance but also cause the nostril entrance to collapse, making breathing difficult.[1].

How does the approach change depending on the severity of the elevation?

Mild elevation can reportedly be corrected by inserting thin cartilage at the alar rim.[1]For moderate to severe elevation exceeding 3 mm, a more extensive approach is reportedly needed.[3].

For severe elevation exceeding 3 mm where other methods cannot sufficiently extend the alar rim, composite grafting using ear skin and cartilage together may be considered.[4]Composite grafting can also be combined with other methods.[4].

What is the difference between a cartilage problem and a skin shortage?

Because different tissues are lacking, the choice of method changes. If the alar cartilage position is displaced, a method to lower and re-support the cartilage position is appropriate.[1]When internal nasal skin is insufficient, composite grafting from the ear or skin advancement and stretching techniques are commonly used.[3].

It has been noted that most alar lowering methods cannot add soft tissue inside the nose, so inadequate lowering sometimes occurs.[2]It has been written that when both skin and cartilage are lacking, composite grafting is the only option.[1]Often the cause is not a single factor, and it is stated that a single method is difficult to correct.[3].

How much does the alar rim lower after surgery?

In a study of 47 people who underwent alar lowering with cartilage grafting, the distance between the alar rim edge and nostril axis decreased by an average of 2.7 mm.[1]However, in 7 patients, scar contracture resulted in insufficient lowering, and some returned to the original position.[1].

In the same study, 68% (32 people) were very satisfied, 19% (9 people) were satisfied, and 12% (6 people) were not very satisfied.[1]This is a result following one method for about a year, so it does not necessarily apply directly to other methods.

Things to confirm before surgery

There are three reference points for judgment. The first is whether the cause of nostril visibility is on the alar side or the columella side.[1][2]The second is whether the elevation exceeds 3 mm.[3][4]The third is whether what is lacking is cartilage or skin and internal nasal tissue.[1][3].

The cause and degree of alar rim elevation are difficult to determine by looking in a mirror alone. Including the details of any previous nasal surgery, have your physician examine your profile and the inside of your nose during consultation.