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Alar rim graft

Ting-Chen Lu, Chuan-Fong Yao, Susie Lin, Chun-Shin Chang, Philip Kuo-Ting Chen
PROPOSE: Since 2006, we have explored the option of using septal cartilage as an alar rim graft on the cleft side during primary rhinoplasty to improve nasal symmetry. The aim of this study was to compare the nasal shape with or without rim graft. METHODS: A total of 98 patients with unilateral complete cleft lip and palate were included; 39 patients had septal cartilage as the rim graft, 59 patients did not. Measurements of the nostril height, nostril width, 1/4 medial part of nostril height, nostril area, nasal dome height and nostril axis were made on the cleft and non-cleft side...
January 13, 2017: Plastic and Reconstructive Surgery
Jennifer L Goodrich, B J F Wong
The alar lobule, alar margin, and soft triangle facet are receiving more attention in the literature as critical elements to address both preoperatively and during rhinoplasty. We have found that the use of the articulated alar rim graft (AARG) corrects deficiencies in these areas as well as provides mechanical stability to the external valve. In this article, we describe indications for AARG, describe in detail the procedure for AARG placement, and highlight the transformation AARGs can achieve in two illustrated case studies...
December 2016: Facial Plastic Surgery: FPS
Yong Jun Jang, Sung Min Kim, Dae Hyun Lew, Seung Yong Song
BACKGROUND: Alar retraction is a challenging condition in rhinoplasty marked by exaggerated nostril exposure and awkwardness. Although various methods for correcting alar retraction have been introduced, none is without drawbacks. Herein, we report a simple procedure that is both effective and safe for correcting alar retraction using only conchal cartilage grafting. METHODS: Between August 2007 and August 2009, 18 patients underwent conchal cartilage extension grafting to correct alar retraction...
November 2016: Archives of Plastic Surgery
Annelyse C Ballin, Haena Kim, Elizabeth Chance, Richard E Davis
Surgical refinement of the wide nasal tip is challenging. Achieving an attractive, slender, and functional tip complex without destabilizing the lower nasal sidewall or deforming the contracture-prone alar rim is a formidable task. Excisional refinement techniques that rely upon incremental weakening of wide lower lateral cartilages (LLC) often destabilize the tip complex and distort tip contour. Initial destabilization of the LLC is usually further exacerbated by "shrink-wrap" contracture, which often leads to progressive cephalic retraction of the alar margin...
August 2016: Facial Plastic Surgery: FPS
Ergin Yucel, Murat Sahin Alagoz, Guler Gamze Eren, Emrah Kagan Yasar, Hakki Hayrettin Izmirli, Gokhan Duruksu, Serkan Isgoren, Bahar Muezzinoglu, Erdal Karaoz
OBJECTIVE: Chondrocutaneous composite grafts figure among the reconstruction alternatives for alar rim defects resulting from tumor resection and trauma. The major problem with composite grafts is the limited graft survival area. In the present study, the authors aimed to increase the survival area of composite grafts by utilizing the ability of stem cells to promote neovascularization which is crucial in composite graft viability. METHODS: The study included 36 adult Wistar Albino rats, which were allocated to 6 groups...
July 2016: Journal of Craniofacial Surgery
Holger G Gassner, Franziska Schwan, Frank Haubner, Gustavo A Suárez, Veronika Vielsmeier
Secondary cleft rhinoplasty represents a particular surgical challenge. The authors have identified the deficit in skeletal projection of the cleft-sided piriform rim as an important contributor to the pathology. A graft is described to augment the piriform crest on the cleft side. This foundation graft is suture fixated to the piriform crest after complete release of all soft tissue attachments to the alar base. The foundation graft is articulated with a long alar strut graft, which allows for powerful projection of the cleft-sided nasal tip...
April 2016: Facial Plastic Surgery: FPS
Kun Hee Lee
A 19-year-old female patient visited our clinic for rhinoplasty. She complained about her low take-off point, which was apparent in profile view, and wanted slight tip projection. She refused additional cartilage harvesting from ears or ribs but consented to the use of homologous tissue, including acellular dermal matrix, for her dorsum and tip. Septoturbinoplasty was performed, and only a very small amount of septal cartilage could be harvested. It was used as both the columellar strut and the alar rim graft...
December 2015: Plastic and Reconstructive Surgery. Global Open
Jacob G Unger, Jason Roostaeian, Kevin H Small, Ronnie A Pezeshk, Michael R Lee, Ryan Harris, Rod J Rohrich
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...
January 2016: Plastic and Reconstructive Surgery
Nazim Cerkes
Nasal tip deficiency can be congenital or secondary to previous nasal surgeries. Underdeveloped medial crura usually present with underprojected tip and lack of tip definition. Weakness or malposition of lateral crura causes alar rim retraction and lateral nasal wall weakness. Structural grafting of alar cartilages strengthens the tip framework, reinforces the disrupted support mechanisms, and controls the position of the nasal tip. In secondary cases, anatomic reconstruction of the weakened or interrupted alar cartilages and reconstitution of a stable nasal tip tripod must be the goal for a predictable outcome...
January 2016: Clinics in Plastic Surgery
Christian A Paquet, Sim Choroomi, Andrew S Frankel
IMPORTANCE: Cephalically malpositioned lateral crura are a frequent cause of alar rim retraction during both primary and revision rhinoplasty. OBJECTIVE: To demonstrate the efficacy of lateral crural repositioning as an isolated maneuver as and combined with adjunctive grafts for lowering the alar rim. DESIGN, SETTING, AND PARTICIPANTS: From August through December 2014, we retrospectively reviewed the cases of 54 patients (102 hemi-noses) who had lateral crural repositioning performed by the same surgeon between 2007 and 2013...
March 2016: JAMA Facial Plastic Surgery
Cemal Alper Kemaloğlu, Mehmet Altıparmak
BACKGROUND: Alar cartilage malposition is a common anatomic variation in which the axis of the lateral crus lies cephalically and may be parallel to the cephalic septum. Malposition of the lateral crura may produce inward collapse of the alae that is observable on deep inspiration. OBJECTIVES: The authors performed the alar rim flap technique to treat patients with alar malposition and assessed functional and aesthetic outcomes. METHODS: Twelve patients who underwent primary open rhinoplasty with the alar rim flap technique were evaluated in a prospective study...
November 2015: Aesthetic Surgery Journal
Wentao Lin, Yong Qing, Jia Liu, Ying Cen
BACKGROUND: The nasal ala plays an important role in the aesthetic appearance of the nose. Repairing the nasal alar defect, especially full-thickness alar defect, is one of the difficulties of plastic surgeons. In this article, a new surgical method is introduced about repairing full-thickness alar defect with free auricular composite flaps and local nasal alar rotation and advancement tissue flaps. MATERIALS AND METHODS: We retrospectively reviewed 6 patients with a diagnosis of full-thickness alar defect between 2010 and 2013...
March 2015: Journal of Craniofacial Surgery
Bahman Guyuron, Yaas Bigdeli, Ali Sajjadian
BACKGROUND: The purpose of this study was to review the dynamics and frequency of the use of the alar rim graft. METHODS: The recorded intraoperative information for the purpose of rhinoplasty research was reviewed to investigate the frequency of the use of alar rim grafts. Intraoperative observations were also made while inserting the alar rim graft to identify the changes that occur in the structures that could be influenced by placement of this graft. The data were tabulated in an Excel file and analyzed...
April 2015: Plastic and Reconstructive Surgery
Ali Manafi, Amir Eslami Shahr Babaki, Golnoush Mehrabani, Abtine Shahlaee, Amir Manafi
BACKGROUND: The ala of the nose, with its particular texture and characteristics, poses both aesthetically and functionally intriguing challenges and is rather problematic regarding choices for reconstructive methods. Both flaps and grafts have been used to restore natural structure of nasal ala. The present study summarizes a ten-year experience of reconstructive surgery using small composite grafts from non-cartilage bearing tissues, and large composite grafts, containing cartilaginous tissue, with a mean follow-up of 4 years and 8 months...
January 2013: World Journal of Plastic Surgery
Ronald P Gruber, Paige Fox, Anne Peled, Kyle A Belek
BACKGROUND: Alar rim contour and alar rim grafts have become essential components of rhinoplasty. Ideally, grafts of the nose should be anatomical in shape. So doing might make grafts of the alar rim more robust. The authors considered doing that by applying the graft as a continuous extension of the lateral crus. METHODS: Twelve patients (two men and 10 women) constituted the study group (seven primary and five secondary cases). Of those, there were five concave rims, two concave rims with rim retraction, two boxy tips, and three cephalically oriented lateral crura...
December 2014: Plastic and Reconstructive Surgery
Ibrahim Ercan, Denizhan Dizdar, Barış Erdoğan
BACKGROUND: Currently, clinicians better understand the functional and aesthetic consequences of a cephalic malpositioned lateral crus of the lower lateral cartilage, which was identified 30 years ago. Functionally, cephalic malpositioning causes alar support deficiency, which results in external valve insufficiency. Cosmetically, it causes alae nasi retraction, alar bracket deformity, boxiness, and underprojection of the nasal tip. The stair-step technique, defined by Boccieri and Raimondi, is an effective repositioning technique for the repair of this deformity...
October 2014: Aesthetic Plastic Surgery
Ju Young Go, Goo-Hyun Mun, Sa Ik Bang, Kap Sung Oh, So Young Lim
BACKGROUND: Among the many secondary deformities in cleft-lip nose, the alar-columella web is unsightly and is a recurrent deformity. The purpose of this article is to revisit the correction of alar web deformity in patients with cleft-lip nasal deformities and to introduce our web graft technique. METHODS: Thirteen patients with alar webbing underwent surgery between June 2012 and February 2013. The age range of the patients at the time of surgery was 14-29 years...
October 2014: Aesthetic Plastic Surgery
Geon Kim, Young-In Jeong, Hyun-Chul Shim, Ji-Hyun Choi, Mihn Sook Jue, Eun-Jung Kim, Ok-Ja Joh, Hyang-Joon Park
No abstract text is available yet for this article.
June 2014: Annals of Dermatology
Hyun-Chul Shim, Geon Kim, Ji-Hyun Choi, Ji-Hye Kim, Eun-Jung Kim, Hyang-Joon Park, Ok-Ja Joh, Sook-Ja Son
A 65-year-old woman with a deeply infiltrating basal cell carcinoma in the right ala underwent full-thickness excision of most of the ala, including the alar rim, crease, and the adjacent cheek, leaving a 'through-and-through' defect. Reconstruction was performed by using the reverse nasolabial flap and a cartilage graft across the alar defect, harvested from the concha, to prevent nostril collapse and to maintain the alar shape. The reverse or turnover nasolabial flap is a variant of the conventional nasolabial flap; however, it may be more suited for the repair of a full-thickness, lateral alar defect...
June 2014: Annals of Dermatology
Kulwant S Bhangoo
Rhinoplasty is one of the most challenging surgical procedures in plastic surgery. It is not surprising that a significant number of patients end up with unfavourable outcomes. Many of these unfavourable outcomes could be the result of poor judgment and wrong decision making. Most frequently, the unfavourable outcome is the result of errors in surgical technique. In this paper, unfavourable outcomes resulting from errors in surgical technique are discussed under the heading of each operative step. Poor placement of intra-nasal incision can result in internal valve obstruction...
May 2013: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
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