Alar retraction: etiology, treatment, and prevention

Ashlin J Alexander, Anil R Shah, Minas S Constantinides
JAMA Facial Plastic Surgery 2013, 15 (4): 268-74

IMPORTANCE: 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 (nā€‰=ā€‰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.


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