Condition
Alar Retraction After Rhinoplasty
Alar retraction is a nostril rim pulled upward after rhinoplasty. What causes it, whether it affects breathing, and how grafts correct it.
ABFPRS
Facial Plastic & Reconstructive Surgery
ABOto
Otolaryngology — Head & Neck Surgery
AAFPRS
Fellowship Director
Overview
Alar retraction is a nostril rim that sits too high after rhinoplasty, often exposing more nostril than desired. Because the rim is both highly visible and scar-sensitive, repair calls for careful, structural correction.
Key takeaways
- Alar retraction is an upward-pulled nostril rim that can expose excess nostril.
- Causes include cartilage over-resection, scar contraction, weak cartilage, or anatomy.
- It can be purely cosmetic or contribute to external valve weakness.
- Repair may use alar rim, composite, or lateral crural strut grafts.
- Because the rim is highly visible and scar-sensitive, correction is delicate.
An Established Academic Authority
Double board certification. Fellowship director. Published author. A surgeon's surgeon.
ABFPRS
Board Certified
American Board of Facial Plastic & Reconstructive Surgery
ABOto
Board Certified
American Board of Otolaryngology — Head & Neck Surgery
AAFPRS
Fellowship Director
American Academy of Facial Plastic and Reconstructive Surgery
Textbook
Published Author
Contributions to the academic literature of facial plastic surgery
Dual board certification in both Facial Plastic & Reconstructive Surgery and Otolaryngology — Head & Neck Surgery.
Castle Connolly Top Doctor — Plastic Surgery, 2026Overview
Key takeaways
- The nostril rim sits higher than normal, exposing too much nostril.
- On a natural nose, about 2–4 mm of the column between the nostrils shows in profile; alar retraction increases this beyond a natural-looking range.
- After rhinoplasty, it usually follows cartilage over-removal or scar contraction.
- It can also weaken the nostril's support and affect breathing.
- Repair uses small grafts to lower and support the rim.
What it looks like
- From the side, the nostril opening looks large or "arched," with the rim pulled up away from the column between the nostrils.
- From the front, the nostrils may look more visible than before.
- The rim may look notched, uneven, or different on each side.
Why it happens
The nostril rim is supported by the edge of the lower lateral cartilages. After rhinoplasty, alar retraction usually results from:
- Over-resection — too much of that cartilage removed to refine the tip
- Scar contraction pulling the rim upward as healing progresses
- Weak or naturally high-set cartilage, which some people are born with
- Lining loss inside the nostril from prior surgery or injury
Some people have a naturally high nostril rim without ever having surgery; the principles of repair are similar.
Does it affect breathing?
It can. The rim is part of the external nasal valve. When the support that holds it in position is weakened, the nostril may collapse inward on deep breaths. Where that's happening, it's corrected at the same time as the appearance. See nasal valve collapse after rhinoplasty.
How alar retraction is corrected
Repair depends on how high the rim sits and what's missing:
Severity Typical repair
--- ---
Mild (about 1–2 mm) Alar rim grafts — slender cartilage strips placed along the rim to support and slightly lower it
Moderate Lateral crural strut grafts or repositioning of the tip cartilages, combined with rim grafts
Severe, or with lost lining Composite grafts — a small piece of ear cartilage with its skin attached, placed inside the nostril to add both lining and support
These are performed as part of revision rhinoplasty, usually with other refinements. Graft material may come from the septum, ear, or rib. Patients who notice dynamic rim movement can also read about why nostrils flare.
What can realistically be achieved
The nostril rim is thin, highly visible, and sensitive to scar, and it can only be moved so far. Mild and moderate retraction can often be improved substantially; severe retraction can be improved but may not be fully corrected. Symmetry between the two sides is a particular focus. A realistic goal is set at the consultation after examination.
Frequently Asked
Alar Retraction After Rhinoplasty — patient questions, honestly answered.
It often results from over-resection of the lower lateral cartilage during a prior operation, scar contraction pulling the rim upward, weak cartilage, or natural anatomy. After surgery, scar and loss of rim support are the more common causes.
Sometimes. In many patients it is a cosmetic concern that exposes more nostril than desired. In others, the same loss of rim support contributes to external nasal valve weakness or collapse, which can affect breathing and is addressed at the same time.
Continue exploring
Related rhinoplasty resources
Revision Rhinoplasty
Lowering and supporting the nostril rim after prior surgery.
Pinched Nose After Rhinoplasty
A related loss of tip and rim support.
Nasal Valve Collapse Treatment
Addressing external valve weakness when present.
Rib Cartilage Revision Rhinoplasty
Grafting options for rim reconstruction.
Schedule a consultation
Have alar retraction evaluated by Dr. Mourad.
Next step
Plans are individualized. The consultation is where that begins.
Reach the Manhattan office to schedule a private consultation with Dr. Mourad.