Alar Contour Grafts in Rhinoplasty: A Safe and Reproducible Way to Refine Alar Contour Aesthetics

Overview

The nostril rim can retract, notch, collapse or become uneven after rhinoplasty, because the soft triangles scar and the area has little natural structural support. The authors compared consecutive first-time rhinoplasty patients who received a small cartilage graft along the rim with an equal number who did not, using before and after photographs.

Sections of note

• 50 consecutive primary rhinoplasty patients with alar contour grafts, and 50 consecutive primary patients without them as controls.
• Retraction, notching, collapse and asymmetry were assessed from front, side and base views on a four-point scale.
• Follow-up ranged from 1 to 4 years.
• The two groups started out similar, with an average difference in preoperative scores of 0.21 (p = 0.24).
• Without grafts, retraction, notching and collapse all significantly worsened after surgery. Asymmetry did not change significantly.
• With grafts, notching, collapse and asymmetry all improved significantly. Retraction did not change significantly. Overall the ungrafted group worsened by 0.32 points and the graft group improved by 0.33 points, both p less than 0.01. Level of evidence 3.

What it means for a patient

• Without a rim graft, the nostril rim measurably deteriorated after routine first-time rhinoplasty in this series.
• The graft improved notching, collapse and unevenness, but did not significantly change existing retraction, so it prevents and refines rather than fixing a pulled-up rim.
• Follow-up of one to four years is long enough for the late changes the authors describe.
• Groups were not randomly assigned, the surgeon chose who received grafts, and grading was done from photographs rather than by patients.

Why this paper matters

Nostril rim deformities are visible, difficult to correct later, and often attributed to the original surgery. Showing measurable worsening without grafts and improvement with them supports adding the graft routinely. Because assignment was not random, patients who received grafts may have differed in ways the preoperative scores did not capture.

Terms

• Alar contour graft: a thin strip of cartilage placed along the nostril rim to support its shape.
• Alar retraction: a nostril rim pulled upward, showing too much nostril.
• Notching: a visible dent or step in the nostril rim.
• Alar collapse: inward falling of the nostril wall, which can obstruct breathing.
• Soft triangle: the small soft area of the nostril rim just below the tip, containing no cartilage.