The Modified Alar Batten Graft as a Tip-Alar Superstructure: A Technique to Restore Soft Triangle Stability and...

Lateral nasal wall insufficiency and external nasal valve collapse are frequent causes of both functional impairment and aesthetic deformity following primary or previous nasal surgery. Traditional alar batten grafts provide structural reinforcement but have a limited impact on alar margin contour and tip-alar harmony. We present a modification of the classic batten graft, placed over the lateral crura as a superstructure following tip framework construction during open rhinoplasty, through an illustrative case. The graft is carved in a trapezoidal configuration and secured at the domal level, allowing controlled modulation of tip contour and external valve support. The modified graft provided structural reinforcement of the lateral nasal wall and improved nasal tip aesthetics. Graft placement stabilized the soft triangle and restored continuity of the alar-tip unit by improving alar retraction and tip definition. Postoperatively, the patient reported a Nasal Obstruction Symptom Evaluation (NOSE) score of 5 and a Rhinoplasty Outcome Evaluation (ROE) score of 87.5, with no reported complications. The modified batten graft is a versatile technique that addresses both the functional and aesthetic components of zone II lateral nasal wall insufficiency. It represents a useful option for selected patients requiring simultaneous external valve support and refinement of nasal tip contour.