Journal archive · Rib, ear and septal grafts · Nasal tip · Outcomes, satisfaction and psychology · 2025
Alar Battens Grafts Versus Lateral Crural Strut Grafts: A Systematic Review of Postoperative Outcomes
Jackson JM, DeSisto NG, Sharma RK, Walden R, Yang SF, Stephan SJ, Patel PN.
In the archive as a landmark paper: the core sweep runs 2011–2026, and this one is here because the history of rhinoplasty rests on it · cited on internal nasal valve.
Abstract
Objective: To systematically compare functional outcomes and postoperative cosmetic satisfaction following alar batten graft (ABG) versus lateral crural strut graft (LCSG) placement for patients with nasal valve incompetence.
Data Sources: Pubmed and Embase searches (1995-2025) with terms for nasal obstruction, LCSG, ABG, and functional/cosmetic outcomes.
Review Methods: Relevant studies with documented preoperative nasal valve incompetence, confirmed surgical intervention with either ABG or LCSG, and their associated postoperative outcomes were identified. Review methods adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Due to heterogeneous study designs and incomplete variance data, the findings are presented as ranges without a quantitative meta-analysis.
Results: Fifteen studies (n = 1052 patients; LCSG = 690, ABG = 362) were included. Among eight LCSG studies, mean nasal obstruction symptom evaluation (NOSE) score improvements ranged from 15.8 to 65.6 points, and visual analog scale (VAS)-function improvements ranged from 10.1 to 44.3 points. Seven ABG studies demonstrated NOSE improvements of 25.6 to 69.0 points, and VAS-function improvements ranged from 24.0 to 54.5 points. Validated cosmetic patient-reported outcome measures (Standardized Cosmesis and Health Nasal Outcomes Survey [SCHNOS]-C, VAS-cosmesis, and Facial Aesthetic Clinical Evaluation-Questionnaire [FACE-Q]) were used in LCSG cohorts, showing consistent esthetic gains. No ABG studies employed a standardized cosmetic measure. Heterogeneity precluded pooled analysis.
Conclusion: Both ABG and LCSG yield substantial functional improvements for nasal valve incompetence across numerous studies. Cosmetic satisfaction appears favorable for LCSG but is undercharacterized for ABG due to a lack of reported standardized patient outcome measures. Large, prospective, and multi-institutional studies investigating outcome differences are needed, given the significant heterogeneity across study methods in the existing literature.
Abstract as indexed by PubMed; the article is open access (PubMed Central).
Citation
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What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Rib, ear and septal grafts
Modern rhinoplasty builds rather than removes, so the operation runs on cartilage: the septum first, then the ear, then the rib, and when none of those will do, a piece of donated rib from a tissue bank.
Nasal tip
Tip surgery is now a support problem rather than a sculpting problem: the septal extension graft holds projection and rotation where the columellar strut loses them (0.2% against 4.7% projection loss at one year), and the current series repair, reposition and reinforce the lower lateral cartilages instead of excising them.
Outcomes, satisfaction and psychology
Rhinoplasty is measured with ten different questionnaires, none of which covers both the way the nose looks and the way it breathes, and the best-developed one has no airway questions at all.
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