What is Alar Rim Retraction?

Alar Rim Retraction, also known as alar notching, is the lifting of the outer edge of the nostrils, which can make the nose’s proportions appear uneven. The edge of the nostrils, known as the alar rim, is typically a smooth curve from the front of the nostrils, joining the septum (the tissue separating the two nostrils) to the cheeks.  

It is normal for the alar rim to sit around 2mm higher than the midline of the nostrils. In cases where the nostril edge sits higher than this, openings of the nostrils, known as the alar base, may look out of proportion or appear pointed or triangular. Although these changes can be affected by only a few millimetres, Alar Rim Retraction can create harsher nose contours, which may lead to a less approachable overall facial expression.

Alar Rim Retraction can arise for many reasons, leading to self-consciousness about an individual’s nose. Speaking to a qualified plastic surgeon who specialises in nose and nostril shaping surgery is the best way to establish the most effective treatment plan for your concerns. 

How Does Alar Retraction Correction Differ from Alar Base Reduction?

Alar Retraction Correction and Alar Base Reduction are both surgical procedures performed during Alarplasty surgery. Both address the size and shape of the nostrils. Alar Retraction Correction focuses on the position of the nostrils' edges, whereas Alar Base Reduction narrows the overall size and width of the nostril openings, creating a more proportionate appearance to the lower nose. 
 
Alarplasty procedures can be performed as standalone surgeries or combined with other surgeries to address cosmetic and functional nose concerns such as Rhinoplasty, Septorhinoplasty or Nose Tip Rhinoplasty. Your surgeon will discuss the best options to address your concerns during your consultation. 

What Causes Alar Rim Retraction?

Generally, Alar Rim Retraction is caused by the positioning of the lower lateral alar cartilage in the nose, called the lateral crura. Until recently, it was believed that previous Rhinoplasty surgery was almost the sole cause of a retracted alar rim. However, recent studies have shown that nostril retraction is more common in the general population (including those who have never undergone nose surgery) than previously thought. Your surgeon will consider the cause of your retracted nostrils when determining the best procedures and treatments to address your concerns.  

Genetics: The size and shape of our nostrils can be impacted by our genetics. Having direct family members who have a naturally raised alar edge may mean you are more likely to experience this yourself. This can be due to having a smaller lateral crura or the alar cartilage sitting higher on the sides of the nose than it may typically be for other individuals.

Injury or trauma: Injury to the nasal cartilage may cause the alar rim to rise or have to be repositioned, changing the shape and size of the nostrils or causing alar notching. Before considering surgery, it is essential to ensure that your nose is completely healed and recovered.

Previous nose surgery: Whether addressing an injury or for cosmetic reasons, nose surgery can sometimes lead to Alar Rim Retraction. Cephalic Trim is a common technique used in Rhinoplasty procedures to address a boxy nose tip or a hooked nose. This involves removing a portion of the alar cartilage to soften the tip of the nose. If performed too aggressively, it can result in nostril retraction. If you have experienced retracted nostrils after Rhinoplasty, it is important to speak with your original surgeon to discuss a solution before considering Revision Rhinoplasty with a different provider.

During your consultation, your surgeon will discuss your concerns and reasons for considering nostril surgery. This will help them to understand the cause of your alar retraction, which will influence the surgical plan they develop for you. 

Alar Rim Retraction Before and After

If retracted alar is a concern you are seeking to address, your surgeon will show you a range of Alar Rim Retraction before and after photos during your consultation. These will be of their previous patients with concerns and desired outcomes similar to yours for the best comparison. The Alar Rim Retraction before and after images they show will include several treatment plans, including standalone nostril surgery as well as more comprehensive surgeries such as Septorhinoplasty, which involve the entire nose.

Alar Rim Retraction before and after images are a crucial factor to consider when gathering information about nostril reshaping surgery to help you decide on the best surgeon to address your concerns and to understand the results you can achieve. 

What are the Best Treatments for Alar Rim Retraction?

Retracted alar rims are usually corrected through nostril surgery, known as Alarplasty. This effective procedure addresses all concerns affecting the nostrils, including their size, shape, positioning, and movement (known as nostril flare).

During an Alarplasty, the alar cartilage in the lower nose, around the nostrils, is manipulated to create a natural, flattering shape to the alar base. To correct a retracted alar rim, donor cartilage or a synthetic substance is inserted to add volume to the lateral crura, repositioning and extending the edge of the nostril. This improves alar rim definition and enhances the proportions of the nostrils, improving the overall appearance of the nose.  

Alar Retraction Correction can also be performed during other Rhinoplasty procedures to enhance the final result.  

Are there non-surgical treatments for Alar Rim Retraction?

Surgical Alarplasty is considered the most effective method for addressing nostril retraction. As it is permanent, and there aren’t any associated cosmetic risks, such as migration, the results are the highest quality over the long term. Non-Surgical Rhinoplasty involves injecting dermal fillers to change the shape of the nose. However, this technique is typically used to alter the shape of the upper nose, reducing a dorsal hump or Roman nose, rather than to extend retracted alar rims. As dermal filler is more flexible than donor cartilage, the results may be less precise and will require regular maintenance, making this a less suitable method to address retracted nostrils. 

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