Q: Hi Dr. Eppley, I would like to inquiry which scar removal procedure (besides laser treatment which I have tried – result is not so great) will you advise for the alar rim of the nose area? I had my alar size reduced through a surgery a few years back, the cutting was almost around the whole alar (sides). Unlike other scarring on other flat areas, the alar somehow retracts due to different expressions like laughing. Hope to hear from you, much appreciated thanks.
A: From your description you appear to have had alar rim narrowing, presumably as part of a rhinoplasty procedure. Usually that scar is intended to be placed in the ‘hidden’ skin groove between the attachment of the alar rim (nostril) and the skin of the upper lip. Most of the time this area heals very well although on close inspection in some patients the fine white line may be slightly perceptible. What you are describing as a scar problem does not sound exactly like a scar problem per se. Rather it sounds like it is a nostril retraction problem that becomes evident when smiling or other expressions that push the lip up against the nostril. I suspect that the problem is that the nostril shape has been changed (shortened in circumference) that now allows it to move unnaturally. The scar tissue from the prior procedure may also tether the nostril down creating the same problem. Whether it can be improved by any form of scar revision would depend on my assessment of pictures of the scar, both smiling and non-smiling.
Dr. Barry Eppley