27/03/2025
Alar retraction, also referred to as alar notching, is a condition in which the outer margin of the nostril (alar rim) is pulled upwards, resulting in a raised and angular appearance of the alar rim and excessively exposed nostrils. This condition can be either congenital or acquired. Acquired causes of alar retraction typically stem from scarring due to trauma, infection, or previous nasal surgeries.
Filler injections are typically ineffective in correcting alar retraction due to the need for strong structural support in the corrected alar rim. In these instances, a composite graft composed of skin, cartilage, and perichondrium harvested from the ear is a recommended solution. This type of graft offers superior structural support and skin coverage around the alar rim, ensuring the desired shape is maintained and preventing further retraction.
In Photo A, we see a patient exhibiting bilateral alar retraction, with pulled-up and angular alar rim and excessively exposed nostrils. The dotted line outlines the angulated shape of the alar rim.
In Photo B, we observe the same patient post-correction of alar retraction with a composite graft. The dotted line now illustrates the smooth outline of the alar rim, with the issue of nostril over-exposure successfully addressed.