The Treatment of Alar Base Depression in Rhinoplasty with Diced Autologous Cartilage or Mass Cartilage: A Systematic Review

Overview

The alar base is where the sides of the nose meet the upper lip. When it is depressed, the folds beside the nose deepen, the angle between nose and lip narrows and the middle of the face looks flat. How best to build it up remains contested. The authors searched PubMed, Embase, Web of Science and Cochrane from January 2000 to April 2023, with two investigators screening independently.

Sections of note

• Design: systematic review. Level of evidence III.
• 269 articles were retrieved; after removing duplicates and screening, 6 articles covering 165 patients were included.
• Both diced cartilage and mass cartilage produced favorable correction of alar base depression.
• Diced cartilage was credited with better malleability, lighter border contours, a more natural appearance and superior long term effects.
• Mass cartilage was described as offering procedural advantages, with possibly less long term shrinkage and lower risk of shifting position.
• Note the abstract credits diced cartilage with superior long term effects while also stating mass cartilage may resorb less, which are difficult to reconcile.

What it means for a patient

• Both techniques use your own cartilage, and both were reported to work.
• The trade off is between a moldable filling that blends more naturally and a solid piece that may hold its volume better and shift less.
• The authors recommend choosing based on individual patient characteristics rather than a single default.
• Limits: six studies and 165 patients across the whole review, and no pooled outcome or complication rates are reported in the abstract.

Why this paper matters

Alar base depression affects the middle of the face rather than the nose alone, and it is often overlooked in rhinoplasty planning. Assembling the small literature identifies the two established options and their trade offs. With six heterogeneous studies and no pooled numbers, the review cannot rank them.

Terms

• Alar base: the foot of the nostril where the nose meets the upper lip and cheek.
• Alar base depression: hollowing at that junction, flattening the middle of the face.
• Diced cartilage: cartilage cut into tiny pieces so it can be molded like a paste.
• Mass cartilage: a solid block of cartilage placed as one piece.
• Nasolabial fold: the crease running from the side of the nose to the corner of the mouth.
• Resorption: gradual absorption and loss of graft volume by the body.