Alar Base Lining Graft: A New Technique to Prevent and Correct Alar Retraction in Primary and Secondary Rhinoplasty

Overview

Alar retraction is the nostril rim pulling upward, exposing too much nostril and giving a startled look. It is a recognized problem after rhinoplasty and hard to correct. The authors describe a new alar base lining graft used in augmentation rhinoplasty, both to prevent retraction in first time surgery and to treat it in revision cases, and retrospectively reviewed their patients treated between July 2019 and April 2022.

Sections of note

• Design: retrospective review, 42 patients, single institution. Level of evidence therapeutic IV.
• Minimum follow up: 1 year, with postoperative photographs taken and patients reassessed.
• Assessment covered global symmetry, shape and contour of the nose.
• Satisfaction was measured with the Rhinoplasty Outcomes Evaluation questionnaire.
• Patients reported significant satisfaction as measured by the mean postoperative score, though no score values are given in the abstract.
• Alar contracture in secondary rhinoplasty was treated successfully.
• No graft was extruded or collapsed, and wounds healed without reported major infection.

What it means for a patient

• The graft is placed as a lining at the nostril base, addressing the shortage of tissue that causes the rim to pull up.
• It is presented for two purposes: preventing retraction during a first operation and correcting it during a revision.
• No grafts pushed through the skin or collapsed within the follow up period, which are the two structural failure modes for a graft in this location.
• Limits: 42 patients, retrospective, single institution, no comparison group, and satisfaction reported without numbers.

Why this paper matters

Alar retraction is among the harder deformities to correct because it results from missing tissue rather than misplaced structure, and existing repairs often rely on composite grafts from the ear. A dedicated lining graft is a different approach. Whether it holds beyond a year, and how it compares to composite grafting, is unanswered.

Terms

• Alar retraction: upward pulling of the nostril rim, exposing more of the nostril.
• Alar base: the foot of the nostril where it meets the face.
• Lining graft: tissue placed to replace or reinforce the inner surface of the nostril.
• Augmentation rhinoplasty: surgery that adds height or projection to the nose.
• Extrusion: a graft or implant working its way out through the skin.
• Contracture: tightening of scar tissue that distorts the nose.