Correction of alar rim retraction by lateral crural extension graft

Alar rim retraction is a deformity of the alar conformation that can primarily occur in patients who have not undergone surgery or it can represent the outcome of a previous rhinoplasty surgery. Several surgical techniques for the treatment of alar retraction have been described. This study describes the lateral crural extension graft, a versatile and simple graft to correct alar retraction. Between 2015 and 2017, 47 patients who presented alar rim retraction underwent open septorhinoplasty surgery using the lateral crural extension graft. The retraction was assessed by using the classification systems by Kim for frontal view and Gunter for profile view. Postoperative photos with a minimum follow-up of 12 months were compared with preoperative photos by measuring in millimeters the improvement of alar rim retraction. The mean distance between the alar rim and the long axis of the nostril was reduced by 2.7 mm on average (range, 2.1 to 3.8 mm), showing an objective effectiveness of the procedure. In 7 cases, the correction was incomplete due to excessive cutaneous scarring retraction which caused partial recurrence of alar rim retraction. On the basis of a VAS rating scale, 32 (68%) of 47 patients said they were very satisfied with the outcome, 9 (19%) were satisfied and 6 (12%) were not very satisfied. The lateral crural extension graft is a simple and reliable method for correcting alar rim retraction. In cases of severe skin deficiency, it is not sufficient and a composite graft reconstruction must be used.