Alar Retraction

Abstract

The effect of different rhinoplasty maneuvers on alar retraction remains to be elucidated.OBJECTIVE To determine the etiology and treatment of alar retraction based on a series of specific rhinoplasty maneuvers.DESIGN Retrospective review of a single surgeon's rhinoplasty digital photo database, examining preoperative alar retraction from January 1, 2002, to December 31, 2005, in 520 patients. Patients with more than 1 mm of alar retraction on preoperative photographs were identified. Postoperative photographs were examined to determine the effect of specific rhinoplasty maneuvers on the position of the alar margin; these maneuvers included cephalic trim, cephalic positioning of the lower lateral cartilage, composite grafts, alar rim grafts, alar batten grafts, and overlay of the lower lateral cartilage.SETTING Tertiary care academic health center.PARTICIPANTS Forty-five patients with alar retraction met inclusion criteria, resulting in 63 nasal halves with alar retraction. MAIN OUTCOMES AND MEASURES Intraoperative findings, postoperative results.RESULTS Forty-seven percent of the patients (n = 21) had prior surgery; 47% also had cephalically positioned lower lateral cartilages. Among patients with less than 4 mm of cartilage width at the outset, 46% of those who received supportive grafts achieved target correction vs only 7% for patients who did not undergo supportive cartilage grafting. In patients who underwent more than 4 mm of cephalic trim, those who received supportive grafts achieved 46% of target correction vs 11% among those who did not. Ninety-five percent of composite grafts, 69% of alar strut grafts, 47% of alar rim grafts, 43% of vertical lobule division, and 12% of alar batten grafts achieved their target correction values.CONCLUSIONS AND RELEVANCE Alar retraction is a highly complex problem. It can be seen de novo and is associated with cephalically positioned lower lateral cartilages. Structurally supportive grafting-including composite grafts, alar strut grafts, alar rim grafts, vertical lobule division, and alar batten grafts-can improve alar retraction.LEVEL OF EVIDENCE 4.

Correction of alar rim retraction by lateral crural extension graft

“…More often, it is the outcome of previous rhinoplasty surgery with excessive removal of the alar cartilage and/or vestibular skin. The outcome of an aggressive surgery on the alar cartilage and adjoining skin, together with excessive resection, usually brings about weakening of the cartilage that ends up retracting upwards, causing exposure and alteration of the alar-columellar unit 1 .…”

The Pillars of the Nose-Crura Shortening for Over Projected Nose

“…Each lateral crus represents the lateral legs of the tripoid, while the medial crus constitutes the central leg. The "Tripod concept" also highlights the effect of the operative procedure on one limb may have on the spatial position of the entire nasal tip [12], [13], [14], [15] (Figure 2).…”

Correction of the Nasal Ala

“…3 Alar retraction is also prevalent in the general population of unoperated noses, the etiologies of which may be either congenital or traumatic. 8 As such, even the primary rhinoplasty surgeon must be facile with methods to correct this deformity despite the challenge it presents. Many techniques are described to correct the alar retraction including lateral crural strut grafts, alar rim grafts, batten grafts, and composite grafts—all of which aim to support the external nasal valve and lower the alar margin.…”

“…Many techniques are described to correct the alar retraction including lateral crural strut grafts, alar rim grafts, batten grafts, and composite grafts—all of which aim to support the external nasal valve and lower the alar margin. 8 Each of these techniques has their inherent advantages and limitations, but undoubtedly, the wrong reconstructive technique, even if performed flawlessly, can easily disrupt the free margin of the ala and create an unfavorable aesthetic outcome. 9 The chondrocutaneous auricular composite graft is a versatile, effective, and predictable technique for repair of the retracted ala that provides excellent cartilaginous support, cutaneous coverage, and a favorable aesthetic outcome.…”