Auricular composite grafts are commonly used in more severe cases of alar retraction.^9,24,25 It has been the senior author’s experience that the skin and cartilage of the anterolateral surface of the ear, just inferior to the inferior crus, of the opposite ear (example, left ala, right ear) provides the best donor site and the best contour (Fig. 10). If a small composite graft is needed, primary closure of the donor site may be achieved. If a large graft is required, a ‘‘revolving door’’ postauricular flap may facilitate closure (Figs. 10–15).

Composite grafts are easiest to place when undertaking a limited, precise pocket approach. When more extensive revision rhinoplasty is being performed, with wider elevation undertaken, one may have concern that the composite graft will not stay in position. However, the senior author has not found this to be the case. Composite grafts may be used in conjunction with alar batten grafts.

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. Volume and support must be restored to hold the nostril rim in position—this role is fulfilled by the composite graft. The fashioned composite graft is carefully sutured into place.^9,24,25 Typically, the senior author uses 5-0 chromic suture. I place a cotton ball or other light dressing intranasally to apply light pressure for 1 to 3 days (Figs. 16 and 17).

Composite grafts are easiest to place when undertaking a limited, precise pocket approach. When more extensive revision rhinoplasty is being performed, with wider elevation undertaken, one may have concern that the composite graft will not stay in position. However, the senior author has not found this to be the case. Composite grafts may be used in conjunction with alar batten grafts.