Single-Stage Alar Nostril Ring Correction Using Auricular Composite Grafts in Reconstructive Rhinoplasty

Sazgar AA, Sazgar AK, Hatami N, Sazgar MA.

What this paper says

In 45 multiply-operated patients with narrowed nostrils, skin-and-cartilage grafts from the ear's antihelix restored the nostril ring with no graft failures and halved SCHNOS obstruction and cosmesis scores at one year.

Overview

Over-aggressive removal of tissue at the nostril-sill junction in earlier surgery can scar the nostril into a narrow ring (external valve stenosis). The Iranian authors reviewed records from April 2016 to October 2023 of patients treated with auricular composite grafts (ACGs) in a single stage, using SCHNOS obstruction and cosmesis scores before and one year after.

Sections of note

45 patients (38 women, 7 men), mean age 36.4, averaging 2 previous rhinoplasties.
Grafts came from the antihelix and were shaped like parabolic cylinders, 15-21 mm arc length, 6-9 by 3-7 mm flat.
No graft failures, including in 10 patients with previous nasal skin necrosis.
SCHNOS-O fell from 88.44 to 35.44; SCHNOS-C from 88.30 to 35.85 (both P < 0.05).
Follow-up 1 year.

What it means for a patient

A nostril scarred shut by previous surgery can be reopened with living ear tissue in one operation.
Composite grafts are known to be risky because they depend on new blood supply, yet none failed here, even in scarred skin.
Scores remained above zero after surgery, meaning improvement rather than complete resolution.

Why this paper matters

It is a focused series on a disabling and stigmatising revision problem with a validated outcome measure. Limits: retrospective, 45 patients, single centre, no comparison technique.

Terms

Composite graft: a graft containing more than one tissue, here ear skin plus cartilage.
Antihelix: the curved ridge of cartilage inside the ear rim.
External valve stenosis: narrowing of the nostril opening.
Alar-sill junction: where the nostril wall meets the nostril floor.
SCHNOS: a validated nasal questionnaire with obstruction (O) and cosmesis (C) scales; lower is better.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Alar nostril ring correction in patients with multiple previous surgeries is one of the most challenging procedures in reconstructive rhinoplasty. Assessment of patient satisfaction and the technique's failure rate is essential in evaluating its effectiveness. Objectives: In this study, we aimed to assess the outcomes…”

Excerpt; the full abstract is on PubMed.