Complications of Rhinoplasty - Page 6

Alar Retraction

Cephalic resection of the lateral crus of the lower lateral carti lage is commonly undertaken to effect refinement of the nasal tip. If inadequate cartilage is left, then the contractile forces of healing over time will cause the ala to retract (Fig. 39 1). This is a commonly seen sequela of overresection of the lateral crus. The surgical rule of thumb is to preserve at least 6 to 9 mm of complete strip. Nevertheless, an anatomical study of the alar base recognized that in a normal patient population 20% of patients have a thin alar rim. This anatomical variation must be recognized, as these patients may require even more conservative approaches to avoid the risk of alar retraction and/or external nasal valve collapse . Also, vestibular mucosa should be preserved, as excision of vestibular mucosa contributes to scar contracture with alar retraction.

Alar retraction may be treated by cartilage grafts in more minor cases. The area of retraction is marked prior to injection, and a small marginal incision allows dissection of a precise pocket. A contoured cartilage graft (commonly of auricular or septal cartilage) may be inserted into the precise pocket; it should extend inferiorly to the sesamoids and be wide enough to simulate the normal shape of the lateral crus at the dome.

Auricular composite grafts are commonly used in more severe cases. The cymba concha of the opposite ear (e.g., left ala, right ear) provides the best contour. An incision several millimeters from the nostril rim is followed by careful dissection with freeing of adhesions, creating a defect and displacing the alar rim inferiorly. The fashioned composite graft is carefully sutured into place.

[Previous][Continue]

Ask Dr. Becker a question or arrange an appointment for a nose surgery consultation by calling 856-589-NOSE (6673) or emailing us at info@therhinoplastycenter.com.

NOTE: CLICK HERE for information regarding privacy of your medical information. Additionally, all website users must agree to the terms and conditions of this site. Please CLICK HERE to review terms of use.