Nasal alar rim redraping method to prevent alar retraction in rhinoplasty for Asian men: A retrospective case series

Background For an attractive and natural tip contour in Asian rhinoplasty, insertion of a nasal implant and reinforcement of the cartilaginous framework are essential. However, scar contracture, which often results from augmentation with implant insertion and inadequate soft tissue coverage of the framework, is one of the most common causes of alar retraction. This study reports a novel method of redraping soft tissue along the alar rim to prevent alar retraction in Asians.

Methods Twenty young Asian men who underwent primary rhinoplasty with septoplasty were retrospectively reviewed. After the usual rhinoplasty procedures, alar rim redraping was conducted for the soft tissue along the transcolumellar and bilateral infracartilaginous incisions. The longest axis of the nostril (a) and the height of the nostril from that axis (b) were measured in anterior-posterior and lateral views. The preoperative and postoperative ratios (b/a) were analyzed using the paired t-test.

Results All 20 patients showed natural contours of the nasal tip, nostrils, and alae after a mean follow-up of 53.6 weeks (range, 52–60 weeks). The ratio of the nostril axes significantly decreased postoperatively in all patients except one, by an average of 11.08%±6.52% in the anterior-posterior view and 17.74%±8.49% in the lateral view (P<0.01). There were no complications, including asymmetry, contracture, subdermal plexus injury, flap congestion, or infection.

Conclusions A quantitative analysis of alar retraction by evaluating the ratio of nostril axes showed that alar rim redraping is a simple and effective adjuvant technique for preventing alar retraction in rhinoplasty for young Asian men.

Ala - Asian - Rhinoplasty

*Current affiliation of Jun Ho Choi is WONJIN Plastic Surgery Clinic, Seoul, Korea.

Publication History

Received: 21 June 2020

Accepted: 13 November 2020

Article published online:
20 March 2022

• REFERENCES

• 1 Yang CE, Kim SJ, Kim JH. et al. Usefulness of cross-linked human acellular dermal matrix as an implant for dorsal augmentation in rhinoplasty. Aesthetic Plast Surg 2018; 42: 288-94
• 2 Hong JP, Yoon JY, Choi JW. Are polytetrafluoroethylene (Gore-Tex) implants an alternative material for nasal dorsal augmentation in Asians?. J Craniofac Surg 2010; 21: 1750-4
• 3 Kim H, Han K. Asian rhinoplasty: correction of the short nose with a septal integration graft. Semin Plast Surg 2015; 29: 269-77
• 4 Lee SH, Koo MG, Kang ET. Septal cartilage/ethmoid bone composite graft: a new and improved method for the correction underdeveloped nasal septum in patients with short noses. Aesthetic Plast Surg 2017; 41: 388-94
• 5 Kim EK, Daniel RK. Operative techniques in Asian rhinoplasty. Aesthet Surg J 2012; 32: 1018-30
• 6 Han SE, Han K, Choi J. et al. Modified direct-type septal extension grafts: their stability and usefulness in Asian rhinoplasty. Ann Plast Surg 2017; 78: 243-8
• 7 Lam SM. Aesthetic facial surgery for the Asian male. Facial Plast Surg 2005; 21: 317-23
• 8 Gunter JP, Rohrich RJ. Lengthening the aesthetically short nose. Plast Reconstr Surg 1989; 83: 793-800
• 9 Scattolin A, Galzignato PF, Longari F. et al. Septal extension graft in “closed” revision rhinoplasty: a simplified technique. Am J Rhinol Allergy 2017; 31: 260-4
• 10 Lan MY, Jang YJ. Revision rhinoplasty for short noses in the Asian population. JAMA Facial Plast Surg 2015; 17: 325-32
• 11 Rohrich RJ, Hoxworth RE, Kurkjian TJ. The role of the columellar strut in rhinoplasty: indications and rationale. Plast Reconstr Surg 2012; 129: 118e-125e
• 12 Rohrich RJ, Kurkjian TJ, Hoxworth RE. et al. The effect of the columellar strut graft on nasal tip position in primary rhinoplasty. Plast Reconstr Surg 2012; 130: 926-32
• 13 Paik MH, Chu LS. Correction of short nose deformity using a septal extension graft combined with a derotation graft. Arch Plast Surg 2014; 41: 12-8
• 14 Gruber RP. Surgical correction of the short nose. Aesthetic Plast Surg 2002; 26 Suppl 1: S6
• 15 Park JH, Mangoba DC, Mun SJ. et al. Lengthening the short nose in Asians: key maneuvers and surgical results. JAMA Facial Plast Surg 2013; 15: 439-47
• 16 Kim JH, Park SW, Oh WS. et al. New classification for correction of alar retraction using the alar spreader graft. Aesthetic Plast Surg 2012; 36: 832-41
• 17 Hamilton 3rd GS. Form and function of the nasal tip: reorienting and reshaping the lateral crus. Facial Plast Surg 2016; 32: 49-58
• 18 Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997; 99: 943-52
• 19 Boahene KD, Hilger PA. Alar rim grafting in rhinoplasty: indications, technique, and outcomes. Arch Facial Plast Surg 2009; 11: 285-9
• 20 Gunter JP, Rohrich RJ. Correction of the pinched nasal tip with alar spreader grafts. Plast Reconstr Surg 1992; 90: 821-9
• 21 Lee Y, Kim J, Lee E. Lengthening of the postoperative short nose: combined use of a gull-wing concha composite graft and a rib costochondral dorsal onlay graft. Plast Reconstr Surg 2000; 105: 2190-9
• 22 Kim SK, Kim HS. Secondary Asian rhinoplasty: lengthening the short nose. Aesthet Surg J 2013; 33: 353-62
• 23 Kao WTK, Davis RE. Postsurgical alar retraction: etiology and treatment. Facial Plast Surg Clin North Am 2019; 27: 491-504
• 24 Harbison JM, Kriet JD, Humphrey CD. Improving outcomes for composite grafts in nasal reconstruction. Curr Opin Otolaryngol Head Neck Surg 2012; 20: 267-73
• 25 Gunter JP, Rohrich RJ, Friedman RM. Classification and correction of alar-columellar discrepancies in rhinoplasty. Plast Reconstr Surg 1996; 97: 643-8