Nasal Alar Subunit Reconstruction: A Review of Data

Alar reconstruction is common, yet high-quality outcomes data are limited. This review synthesizes the available literature to guide evidence-informed reconstructive choices.

A systematic review identified 35 eligible studies reporting defect characteristics, techniques, and aesthetic, functional, and graft/flap outcomes. Single-patient case reports, purely technical papers, and studies without outcome data were excluded.

Full-thickness skin grafts (FTSG), FTSG with cartilage, and composite grafts have been used with acceptable aesthetic outcomes for small defects. Local flaps are most common for small to intermediate defects, while regional flaps, particularly melolabial (MLF) and paramedian forehead flaps (PMFF), are the primary options for larger defects. PMFFs have higher reported cosmetic satisfaction but may require more secondary procedures.

Standard data and evidence reporting for alar subunit reconstruction is very limited, with a predominance of retrospective and technique-driven studies and gestalt-based outcomes. Standardized reporting of defect size, functional outcomes, and validated patient-reported measures is needed. Until higher-quality data is available, reconstructive decisions should be individualized.