Extended Alar Contour Grafts: An Evolution of the Lateral Crural Strut Graft Technique in Rhinoplasty

Overview

Modern rhinoplasty centers on reshaping the lower lateral cartilages, and the open approach expanded the techniques available. This article reviews the tip grafts already in use and presents a hybrid of two of them, aimed at controlling both the orientation of the tip cartilage and the shape of the nostril rim.

Sections of note

• The ideal tip is described as diamond-shaped, 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.
• Existing techniques listed: lateral crural strut grafts, alar contour or rim grafts, alar strut grafts, subdomal grafts, and suturing techniques such as alar flaring sutures.
• The extended alar contour graft is presented as an evolution of the lateral crural strut graft combined with the alar contour graft.
• The authors state lateral crural abnormalities usually result from an interplay of several factors rather than occurring singly.
• The recurring theme identified is orientation and alar support to prevent isolation of the tip by extended alar grooves.
• The abstract reports no patient numbers, outcome measures, complication rates, or follow-up.

What it means for a patient

• A tip that looks pinched or separated from the rest of the nose is often caused by the deep grooves running alongside it.
• These grafts work by supporting and reorienting the nostril rim rather than by adding height to the tip.
• Problems in this area typically have more than one cause, which is why a combined technique is proposed.
• This is a technique description with no measured results, so it does not report how well the graft performs.

Why this paper matters

Tip refinement that ignores the nostril rim produces a narrowed tip with a visible groove, one of the recognizable signs of an operated nose. Combining rim and strut support addresses both at once. Outcome data comparing it to the individual grafts is not presented here.

Terms

• Lateral crus: The outer arm of the tip cartilage running toward the cheek.
• Lateral crural strut graft: A cartilage strip placed under the lateral crus to support and reposition it.
• Alar contour or rim graft: A small cartilage strip placed along the nostril edge.
• Tip-defining points: The two highest points of the nasal tip, seen as light reflections.
• Supratip: The area just above the tip.