The Utility of the Subalar Graft in Nostril Symmetry in Rhinoplasty

Lee YH, Lee JY, Luo J, Lawson W, Westreich R.

What this paper says

In 68 patients given a subalar graft, the nasal axis moved 4.32 degrees toward the midline and nostril symmetry improved by a mean ratio change of 0.19 toward equal.

Overview

A crooked nose can arise from several anatomical causes, including an asymmetric upper jaw. A subalar graft is placed at the base of the nostril to build up an underdeveloped area of that jaw. The authors set out to show the graft's effect on nostril symmetry and to propose an algorithm for using it in both open and endonasal rhinoplasty.

Sections of note

Retrospective case series; therapeutic level of evidence IV.
Patients operated on by the senior author from September 2008 to July 2015 with at least 3 months follow up and adequate photographs were included.
Sixty eight patients were included; mean follow up 11.0 months, range 3 to 72 months.
Before and after photographs were measured for nasal axis deviation, alar facial angle on base view, alar facial angle on frontal view and nostril show on both sides.
Nasal axis deviation improved by a statistically significant 4.32 degrees toward the midline.
Alar facial angle on base view improved 1.01 degrees toward horizontal.
Nostril symmetry improved by the ratio of the shorter side to the longer side, with a mean change in nostril show ratio of 0.19 toward a 1 to 1 ratio.

What it means for a patient

The graft addresses asymmetry at the foundation of the nose rather than the nose itself.
The measured changes were small in absolute terms, roughly 4 degrees of axis correction.
Measurements came from photographs rather than direct measurement, and follow up varied widely from 3 to 72 months.
There was no comparison group operated on without the graft.

Why this paper matters

Crooked noses often persist after surgery because the underlying facial base is asymmetric, and treating only the nose leaves that cause untouched. This series measures what correcting the base contributes. Whether the change is enough to alter patient perception is not assessed.

Terms

Subalar graft: cartilage placed at the base of the nostril to build up the underlying jaw area.
Maxillary hypoplasia: underdevelopment of the upper jaw bone.
Nasal axis: the line down the middle of the nose, used to measure deviation.
Alar facial angle: the angle at which the nostril wing meets the face.
Nostril show: how much of each nostril is visible from the front.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“A deviated nose can be attributable to multiple anatomical factors, including asymmetric maxilla. A subalar graft helps to correct maxillary hypoplasia and may be a useful tool for correcting a deviated nose. The authors' objective is to show the effects of the subalar graft in improving nostril symmetry and to…”

Excerpt; the full abstract is on PubMed.