Alar Rim Reconstruction With Autologous Graft Cartilage: External Approach

Alar deformities are frequently sequels of the incorrect primary rhinoplasties. Malpositions and irregular cartilage as consequence of either inadequated or exaggerated resection are the skeletal representation not only of aesthetic deformities but also collapse or depression, airway obstruction, valve narrowing by scarring, etc. Replace of alar cartilage is mandatory and many techniques have been described using autogenous cartilage graft since either ear or costal areas. Basically, a pocket must be made inside the thickness of ala permitting the placement of the graft. In our experience the placement of the graft was made by an incision in the fold in the base of the ala and a wide and net alar undermining, carving a pocket was carried out until the tip by means of sharp dissection with the scalpel, permitting the placement of the graft "like a sandwich." The reason for this publication is to describe a surgical technique that permits an exact and correct placement of the graft obtaining the recuperation of normal shape, form projection, and functionality of the ala. The external alar incision is conspicuous and it remains hiding inside natural fold in the alar base.