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Alar rim graft

Yu Kit Li, Andrew Greensmith
Supplemental Digital Content is available in the text.
April 2018: Plastic and Reconstructive Surgery. Global Open
C Spencer Cochran, David A Sieber
Modification of the lower lateral cartilage complex is the sine qua non of modern rhinoplasty, and the open approach to rhinoplasty has expanded the number of techniques available to help achieve an aesthetically pleasing tip. The ideal tip has been described as having a diamond-shaped configuration, with the lateral points formed by the tip-defining points, the superior point by the supratip, and the inferior point by the columellar break point. Over the years, various techniques have been described to minimize isolation of the tip and to help achieve the ideal tip configuration: lateral crural strut grafts, alar contour grafts (i...
October 2017: Plastic and Reconstructive Surgery
Reza Vaezeafshar, Sami P Moubayed, Sam P Most
Importance: Lateral wall insufficiency (LWI) is classified by the zone in which it occurs. Multiple techniques for treating LWI are described in the literature and are used, but no treatment approach has been widely adopted. Objective: To establish an algorithm for treatment of LWI by evaluating subjective and objective outcomes of patients who underwent LWI repair and comparing these results with those of a control group who received no specific LWI repair. Design, Setting, and Participants: This case-control study was conducted in a tertiary referral center...
March 1, 2018: JAMA Facial Plastic Surgery
Serkan Sertel, Ioana-Irina Venara-Vulpe, François Gorostidi, Anthony de Buys Roessingh, Philippe Pasche
INTRODUCTION: The unilateral cleft lip nose is characterized by numerous complex and interdependent deformities. Secondary rhinoplasty techniques aim to correct cleft lip nose deformities by using multiple maneuvers combining septum and nasal spine medialization and alar cartilage, as well as soft tissue mobilization and repositioning. Moreover, cartilage grafting is frequently used to restore adequate tip projection and nasal symmetry. We present a technique of cartilage grafting commonly used in noncleft rhinoplasties that we modified for cases of moderate cleft lip nose deformities...
December 2017: Annals of Plastic Surgery
Emi Funayama, Yuhei Yamamoto, Hiroshi Furukawa, Naoki Murao, Ryuji Shichinohe, Takeshi Yamao, Toshihiko Hayashi, Akihiko Oyama
Full-thickness defects of the entire nasal ala, including the rim, can be challenging to reconstruct. A forehead flap may provide a more imperceptible and natural-appearing reconstructed nasal ala. Previously, many authors have insisted adding cartilaginous infrastructural support for an entire, full-thickness defect to keep the postoperative alar structure symmetrical. They finally use a forehead flap after thinning of the distal covering portion subcutaneously, possibly for a Caucasian-type nasal ala. However, Asian skin has a thicker and more compact dermis than that of Caucasian skin, and the Asian ala is rounder and thicker...
May 2017: Journal of Craniofacial Surgery
Sadrollah Motamed, Hamidreza Alizadeh Otaghvar, Feizollah Niazi, Seyed Mehdi Moosavizadeh, Babak Motaghedi, Adnan Tizmaghz
INTRODUCTION: Surgical manipulation of the lower lateral cartilages of nasal tip could cause subtle but significant responses to the manipulation. The suture-techniques almost always offer a reliable and dramatic method of tip reshaping without a need to break or interrupt the alar rim strip or even adding tip graft. AIM: The aim of this study was to describe and assess outcomes of a new suture technique in rhinoplasty by using cephalic dome septal rotation suture for better tip definition...
January 2017: Journal of Clinical and Diagnostic Research: JCDR
Ting-Chen Lu, Chuan-Fong Yao, Susie Lin, Chun-Shin Chang, Philip Kuo-Ting Chen
BACKGROUND: Since 2006, the authors 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, and 59 patients did not. Measurements of the nostril height, nostril width, one-fourth medial part of nostril height, nostril area, nasal dome height, and nostril axis were obtained on the cleft and noncleft sides...
May 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
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