Sixty-seven patients underwent primary septo­rhino plasty without alar batten grafts. Two patients underwent primary rhinoplasty with ear cartilage harvest but no alar battens. In these cases, valve col-lapse was evaluated but not identified.

One patient for primary septorhinoplasty under-went alar batten grafting because of a congenital abnormality of his lateral crura. Two patients had excessively concave lateral crura contributing to nasal obstruction; in these cases alar batten grafts were not placed, but the lateral crus was excised and "flipped" to achieve both aesthetic improvement and improve­ment in the nasal valve area (Fig. 3).

Six patients underwent revision septorhinoplasty with alar batten grafting, and ten patients underwent revision septorhinoplasty with ear cartilage harvest and alar batten grafting. These patients all reported im­provement in their nasal breathing postoperatively.

Six patients underwent revision rhinoplasty (no septoplasty) with ear cartilage and battens (Fig. 4). Again, these patients hold special interest because noseptoplasty was performed. No other intranasal pro­cedures were performed that affected nasal breathing. These patients did undergo tip rotation and projection resulting from the ptotic, droopy tip. Rotation and projection of the nasal tip does affect nasal breathing. All six of these patients reported significant improve­ment of their nasal breathing.

All patients were informed that the nasal sidewall would have a more full, less "pinched" appearance. All patients who underwent alar batten grafts were satis­fi ed with the aesthetic appearance of this area.

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