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Alar Contour Grafts in Rhinoplasty

A Safe and Reproducible Way to Refine Alar Contour Aesthetics

Unger, Jacob G., M.D.; Roostaeian, Jason, M.D.; Small, Kevin H., M.D.; Pezeshk, Ronnie A., M.D.; Lee, Michael R., M.D.; Harris, Ryan, B.A.; Rohrich, Rod J., M.D.

Plastic and Reconstructive Surgery: January 2016 - Volume 137 - Issue 1 - p 52–61
doi: 10.1097/PRS.0000000000001942
Cosmetic: Original Articles
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Background: Alar rim deformities such as retraction, notching, collapse, and asymmetry are common problems in rhinoplasty patients. Although alar rim deformities may be improved through rhinoplasty, this area is prone to late changes because of scarring of the soft triangles and a paucity of native structural support. The purpose of this study was to analyze the effect of alar contour grafts on primary rhinoplasty.

Methods: Fifty consecutive primary rhinoplasty patients with preoperative and postoperative photographs who received alar contour grafts were evaluated for alar aesthetics; 50 consecutive primary rhinoplasty patients without such grafts served as controls. Differences among alar retraction, notching, collapse, and asymmetry from anterior, lateral, and basal views were evaluated. Follow-up ranged from 1 to 4 years and was graded on a four-point scale.

Results: The average difference between the two groups’ aggregate preoperative scores was 0.21 (p = 0.24). The average preoperative and postoperative scores in the nongraft group were significant for worsening retraction, notching, and collapse but insignificant for asymmetry. The preoperative and postoperative scores for the graft group were insignificant for retraction but improved significantly for notching, collapse, and asymmetry. Postoperatively, the aggregate average of the scores in the nongroup was 0.32 points worse (p < 0.01), whereas the graft group had a 0.33-point improvement (p < 0.01).

Conclusions: Alar contour grafts have a clear and important impact on cosmetic results of primary rhinoplasty. Use of alar contour grafts has been shown to improve aesthetics, whereas there is a worsening of the measured parameters postoperatively without use of these grafts.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Dallas, Texas

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication March 5, 2015; accepted June 23, 2015.

Disclosure:The authors have no financial interest to declare in this research project or in any of the techniques or equipment used in this study. Dr. Rohrich receives instrument royalties from Eriem Surgical, Inc., and book royalties from CRC Press and Taylor and Francis Publishing. No funding was received for this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).

Rod J. Rohrich, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390, rod.rohrich@utsouthwestern.edu

©2016American Society of Plastic Surgeons