A Novel Technique for Nasal Alar Reconstruction

Reconstruction of full-thickness alar defects is delicate. Small asymmetries are visible because of the central position of the nose. Different alar reconstruction techniques such as the nasolabial, bilobed, and composite grafts provide an excellent option to reconstruct alar skin and texture. However, these donor tissues will never perfectly match alar tissue in terms of color and contour. This report presents a case of a 56-year-old woman with alar asymmetry due to soft tissue loss of the right alar rim, para-nasal, and nasolabial groove as consequence of a severe trauma in the past. Scarring tissue, retractions, and suboptimal tissue quality on the right side of the face complicated a standard procedure. In this case, a novel reconstruction technique was planned for alar reconstruction. In a two-staged procedure, a well-perfused alar base flap from the contralateral side was raised to recreate the basal portion of the right lateral alar rim. Concomitantly a lip lifting procedure was performed to correct the inadequate incisal show. As result, perfectly matching skin color, texture, and correction toward alar and facial symmetry were realized. Satisfactory aesthetic outcome for the patient was achieved. The final result was evaluated 12 months postoperatively by the use of stereophotogrammetry technology.