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The major cause of alar retraction is rhinoplasty, which requires surgical correction.
The major cause of alar retraction is rhinoplasty, which requires surgical correction. The excision or aggressive surgical removal of tissue can be a major cause of alar retraction after rhinoplasty. The partial excision of the lower nasal cartilage that extends upper for tip narrowing and rotation causes alar retraction to some extent. Also, the excision in the sidewalls of the nose, particularly in skin cancer, can cause alar retractions.
Other reasons for alar retraction after rhinoplasty include:
- Incorrect suturing
- Excision of the skin present inside the nose along the sides of the nose
- Cartilage splitting technique
- Alar excision (excision of the skin along the sides of the nose, near the nostril)
- Division of the alar cartilage (lower third cartilage)
- Excessive cartilage removal
Apart from rhinoplasty, many other factors may likely cause alar retractions, which include:
- Family history of alar retractions
- Congenital conditions, such as facial clefts
- Injury or trauma
- Part of a normal nose anatomy
- Surgical weakening, bending, or malpositioning of sideways paired nasal tip cartilage (lateral crura)
What is alar rim retraction?
Alar rim retraction or elevation is a nasal deformity in which there is an undesirable elevation of the nostril margin, which results in excessive nostril show. This results in the creation of the abnormal shape. Alar retraction is difficult to assess. The alar rim is the skin along the sides of the nose, near the nostril. The surgical correction of alar retraction involves complex, unpredictable procedures.
Surgical correction is indicated in the following conditions:
- To remove a nasal airway obstruction
- Patient’s desire for change in nasal shape
- Cosmetically unappealing deformities
How to fix alar retraction?
Alar batten graft is effective to treat mild to moderate alar retraction whereas lateral crural strut grafts and alar extension are useful in a moderate to a severe state.
Alar batten graft is a type of cartilage graft placed along the sidewall to support the nose. The physician makes a marginal incision on the side of the nose. Next, the physician makes further dissection with a scissor in that area to loosen the attachment of tissues from the lower cartilage. A precisely sized pocket is made by creating a path down the upper border of the nostril (supra alar crease). The physician places a graft inside the pocket and closes the incision with stitches.
The physician prefers the lateral crural graft for moderate to severe alar retractions. In this type of grafting, the physician uses grafts from the septal cartilage. For this, the physician makes an incision at the lateral crura. The physician creates a pocket by dissecting the tissue attached to the lateral crura. A precisely sized pocket is made to place the graft. Finally, the physician closes the incision with stitches.
For patients not wanting surgery, dermal fillers can fix alar retraction. Dermal fillers are a temporary correction procedure, where dermal fillers are injected to improve the shape of the alar rim. The results typically last for about 12 months.
What are the complications of surgery performed to fix alar retraction?
The complications include:
- Infection
- Postoperative bleeding