The shape of the nostrils and the overlying nostril rims has taken on increased interest in rhinoplasty surgery and its outcomes. Much of this interest in driven by patients who may after a rhinoplasty feel that they show too much of a nostril opening or have nostril asymmetry with one rim of the nostril higher than the other. Alar rim retraction can certainly be created from open rhinoplasty surgery from a variety of tip cartilage shaping techniques.
Some rhinoplasty patients also have a natural concavity to their alar rims or a propensity to it due to thinner or weaker lower alar cartilages. This natural tendency can be exaggerated after rhinoplasty surgery. Both for prevention of alar rim retraction and for improved aesthetics of the transition from the nasal base to the tip (prevention of alar rim concavity), the alar rim cartilage graft has become an integral part of primary and secondary rhinoplasty surgery.
In the April 2015 issue of the journal Plastic and Reconstructive Surgery, an article on this topic appeared entitled ‘Dynamics of the Alar Rim Graft’. In this paper, the senior author reviewed 1,427 rhinoplasties performed of which 565 received alar rim grafts. (40%) In reviewing these cases it was noted that the use of alar rim grafts, which were once used almost exclusively in revisional rhinoplasty, had changed to a more frequent use in primary rhinoplasty surgery more recently. The benefits of such graft use were correction of nostril rim concavity and lengthening and widening of the nostril.
The technical details of the use of alar rim grafts were reviewed. The grafts can be taken from any cartilage source including the resected cephalic border of the lower alar cartilage or scraps left over from a septal graft harvest but the best (stiffest) grafts come from a good piece of thin septal cartilage or rib cartilage. The graft dimensions are usually about 15mms long and 2 to 3mms wide. The grafts are inserted through a small incision just under the nostril rim from which a small linear pocket is made along the rim. In closed rhinoplasties, the incision is anterior with the pocket made down to the base. In open rhinoplasties the incision is made closer to the base and the pocket dissected towards the tip. Either way it is important that the graft does not come too close to the tip so that it does not inadvertently widen it.
This small but elegantly conceived cartilage graft is an important element of rhinoplasty surgery whether it is a primary or revisional procedure. It is helpful to prevent nostril rim concavity and retraction deformities as well as to help lengthen and widen nostril shape.
Dr. Barry Eppley