The Alar Contour Graft: Correction and Prevention of Alar Rim Deformities in Rhinoplasty

Abstract

One of the most common problems affecting both the primary and secondary rhinoplasty patient is deformity of the alar rim. Typically, this deformity is caused by congenital malpositioning, hypoplasia, or surgical weakening of the lateral crura, with the potential for both functional and aesthetic ramifications. Successful correction and prevention of alar rim deformities requires precise preoperative diagnosis and planning. Multiple techniques of varying complexity have been described to treat this common and challenging problem. Over the past 6 years (1994 through 2000), the authors have employed a simple technique in 123 patients for alar retraction that involves the nonanatomic insertion of an autogenous cartilage buttress into an alar-vestibular pocket. Among the 53 patients who underwent primary rhinoplasty in this study, 91 percent experienced correction or prevention of alar notching or collapse. However, correction was achieved for only 73 percent of the patients who underwent secondary rhinoplasty; many of whom had alar retraction secondary to scarring or lining loss. In patients with moderate or significant lining loss or scarring, a lateral crural strut graft is recommended. The alar contour graft provides the foundation in the patient undergoing primary or secondary rhinoplasty for the reestablishment of a normally functioning external nasal valve and an aesthetically pleasing alar contour. This article discusses the anatomic and aesthetic considerations of alar rim deformities and the indications and the surgical technique for the alar contour graft.

Simple Correction of Alar Retraction by Conchal Cartilage Extension Grafts

“…Postsurgical monitoring for >1 year is advisable to check for relapses of alar retraction. Finally, our patient population was small relative to those of the studies by Gunter and Friedman [10], Constantian [2], and Rohrich et al [5]. Thus a larger prospective study with prolonged follow-up is warranted.…”

“…At present, various procedures have been devised to correct alar retraction through composite grafts, grafting of cartilage, and soft tissue advancement [24567891011]. In patients with mild-to-moderate alar retraction, alar contour grafts are effective.…”

“…In moderate-to-severe states, alar spreader grafts, lateral crural strut grafts, and alar extension grafts are useful. Composite grafting is indicated for severe alar retraction [512]. …”

Rhinoplasty Complications and Reoperations: Systematic Review

“…We ran the information from the Excel table through a statistical analysis 14 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 …”

Structural grafts and suture techniques in functional and aesthetic rhinoplasty

“…As Toriumi points out, they may improve support for the external nasal valve and enhance contour by creating a defined ridge between the tip and alar lobule [76]. Measures of alar rim grafts have been reported in the range of 12 to 15 mm in length and 2 to 3 mm in width [77]. The author prefers curved grafts, if they can be crafted from deviated parts of the nasal septum or concha, as shown in Figure 4 (Fig.…”