Alar Retraction: Etiology, Treatment, and Prevention

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Abstract

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 (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.

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