An alar base flap to correct nostril and vestibular stenosis and alar base malposition in rhinoplasty

Nostril and vestibular stenoses can be properly reconstructed by composite grafts from the alar lobule or ear. However, when alar base malposition accompanies the nostril stenosis, composite grafting will enlarge the nostril but not correct the alar base displacement. An alar base flap designed as a crescent adjacent to the alar base, elevated, and transposed on subcutaneous and musculocutaneous perforators corrects the nostril stenosis and repositions the alar base simultaneously. Anterior, active rhinomanometry demonstrates a substantial increase in mean nasal airflow from this reconstructive maneuver alone. The author has used the flap successfully in 29 secondary rhinoplasty patients; survival has been uniformly complete even when the donor tissue has been scarred or burned. All rhinoplasties were performed endonasally, however; the survival of this flap performed simultaneously with open rhinoplasty has not been established.