Q: Dr. Eppley, I am interested in alar base repositioning. I read in a Real Self post you commented on regarding a lady who had one ala that was higher than the other side. You mentioned that you can lower the high alar sidewall through a simple technique. I have the same issue: my left ala is higher than the right, so my nasal sills/base seems it slants up toward the high side, my supra alar crease is 2-3 mm higher as well, and my upper lip also follows this upward slant. I have slight form of hemifacial microsomia where the left side of my face is smaller (and shorter) and less full than the right. Can you tell me what this alar repositioning technique is? How do you lower the higher alar side? I consulted with my local plastic surgeon and he considered an anchor suture technique to try and pull down the high side. The problem is, I had a prior surgery where a different surgeon put a Medpor implant (with screw) in my pyriform aperture and there is a screw there. My current plastic surgeon said he would need to put a screw for the anchor where that screw is currently in for the implant. Was the anchor suture method the method you spoke of in that lady’s post? Can the Medpor implant that I have be removed? And can the anchor be put in its place, using the same screw hole to fasten it?
Just thought I’d ask because you’re the only plastic surgeon that has also mentioned this technique to lower an alar sidewall that is a higher than the other side. You also mentioned in another post of using this method to raise the ala (the opposite), has this been successful? I’d appreciate your advice and information on which technique you were referring to, in order to lower or pull down one alar sidewall that is higher than the other side. I would like to have my higher ala/nasal sill, and upper lip lowered for better symmetry. It seems that when I pull the skin down next to my supra alar crease, everything else goes down with it, and it looks more symmetrical, how I want it. I have yet to find a doctor who can actually do all this, as my asymmetry is due to my facial bones. It sounds like the anchor suture thing would be the thing to do, but then again, I am not a Dr. by any means, so I wanted to ask you since you mentioned a technique to the lady who has the same problem I have.
A: There are two basic ways to lower a higher ala (alar base repositioning), either a skin excision alarplasty or a suture anchor fixation method to the underlying pyriform aperture. I would need to see pictures of your face to determine which may be more appropriate. Your indwelling Medpor implant does not pose a problem for the internal anchor technique. The implant can be maintained.
Dr. Barry Eppley