Facial Plast Surg 2022; 38(01): 070-073
DOI: 10.1055/a-1724-3656
Original Article

Correction of the Nasal Ala

Garrett D. Locketz
1   Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, New York University School of Medicine, New York, New York
,
Alexa Franco
1   Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, New York University School of Medicine, New York, New York
,
Philip J. Miller
1   Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, New York University School of Medicine, New York, New York
› Author Affiliations

Abstract

The alar–columellar relationship is an important concept for the rhinoplasty surgeon to master. The alar rim in particular is a critical component of the nasal tip, contributing to both overall symmetry and proportion of the nasal base. The retracted ala creates a displeasing aesthetic to the tip complex, distorts the nostril openings, and may have functional implications of the external nasal valve. While alar retraction can occur naturally or as the result of trauma, the majority of cases are post-surgical in nature. Many techniques have been described for correction of alar retraction, most of which require open rhinoplasty and many fail to add the soft tissue within the vestibule necessary to properly lower the alar margin. Herein, we present our experience with the auricular chondrocutaneous composite graft—a simple, reliable, and effective technique to correct moderate to severe alar retraction via either open or endonasal rhinoplasty.



Publication History

Accepted Manuscript online:
17 December 2021

Article published online:
14 January 2022

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Gunter JP, Rohrich RJ, Friedman RM. Classification and correction of alar-columellar discrepancies in rhinoplasty. Plast Reconstr Surg 1996; 97 (03) 643-648
  • 2 Guyuron B. Alar rim deformities. Plast Reconstr Surg 2001; 107 (03) 856-863
  • 3 Kridel RWH, Chiu RJ. The management of alar columellar disproportion in revision rhinoplasty. Facial Plast Surg Clin North Am 2006; 14 (04) 313-329, vi
  • 4 Chun J-J, Yoon SM, Wee SY, Choi CY, Oh HS, Jeong HG. Alar rim composite graft: a safe and simple way to correct alar retraction. Arch Aesthetic Plast Surg 2018; 24 (02) 55-61
  • 5 Constantian MB. Indications and use of composite grafts in 100 consecutive secondary and tertiary rhinoplasty patients: introduction of the axial orientation. Plast Reconstr Surg 2002; 110 (04) 1116-1133
  • 6 Cottle MH. The structure and function of the nasal vestibule. AMA Arch Otolaryngol 1955; 62 (02) 173-181
  • 7 Grymer LF. Reduction rhinoplasty and nasal patency: change in the cross-sectional area of the nose evaluated by acoustic rhinometry. Laryngoscope 1995; 105: 429
  • 8 Alexander AJ, Shah AR, Constantinides MS. Alar retraction: etiology, treatment, and prevention. JAMA Facial Plast Surg 2013; 15 (04) 268-274
  • 9 Klinger M, Maione L, Villani F, Caviggioli F, Forcellini D, Klinger F. Reconstruction of a full-thickness alar wound using an auricular conchal composite graft. Can J Plast Surg 2010; 18 (04) 149-151
  • 10 Kao WTK, Davis RE. Davis. Postsurgical alar retraction: etiology and treatment. Facial Plast Surg Clin North Am 2019; 27 (04) 491-504
  • 11 Rohrich RJ, Raniere Jr J, Ha RY. The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 2002; 109 (07) 2495-2505 , discussion 2506–2508
  • 12 Davis RE. Revision of the overresected nasal tip complex. Facial Plast Surg 2012; 28 (04) 427-439
  • 13 Gubisch W, Eichhorn-Sens J. Overresection of the lower lateral cartilages: a common conceptual mistake with functional and aesthetic consequences. Aesthetic Plast Surg 2009; 33 (01) 6-13
  • 14 Davis RE. Nasal tip complications. Facial Plast Surg 2012; 28 (03) 294-302
  • 15 Ballin AC, Kim H, Chance E, Davis RE. The articulated alar rim graft: reengineering the conventional alar rim graft for improved contour and support. Facial Plast Surg 2016; 32 (04) 384-397
  • 16 Meyer R, Kesselring UK. Sculpturing and reconstructive procedures in aesthetic and functional rhinoplasty. Clin Plast Surg 1977; 4 (01) 15-39
  • 17 Ellenbogen R. Alar rim lowering. Plast Reconstr Surg 1987; 79 (01) 50-57
  • 18 Kim JH, Park SW, Oh WS, Lee JH. New classification for correction of alar retraction using the alar spreader graft. Aesthetic Plast Surg 2012; 36 (04) 832-841
  • 19 Hirohi T, Yoshimura K. Surgical correction of retracted nostril rim with auricular composite grafts and anchoring suspension. Aesthetic Plast Surg 2003; 27 (05) 418-422
  • 20 Adams C, Ratner D. Composite and free cartilage grafting. Dermatol Clin 2005; 23 (01) 129-140 , vii