Abstract
Here we describe a new technique to deal with alar retraction, a highly undesirable
imperfection of the nose. The procedure involves placing a caudal extension graft
below the vestibular portion of the lower lateral cartilage (LLC) after its detachment
from the vestibular skin. The graft is fixed to the cartilage and, subsequently, to
the vestibular tissue. The present retrospective study included 20 patients, 11 females
and 9 males, with a mean age of 28.90 years. Follow-up ranged from 1 to 18 months.
Surgery improved alar notching to a smoother dome shape and nostril exposure was reduced
in every patient. The caudal extension graft of the LLC contributed to rise in overall
patient satisfaction, as revealed by the postoperative increase of the Rhinoplasty
Outcomes Evaluation (ROE) mean score from 40.0 to 79.17 (p < 0.0001). It also contributed to and improved functional outcomes, as indicated
by the decrease of the Nasal Obstruction Symptom Evaluation (NOSE) mean score from
52.75 to 13.25 (p = 0.0001). Sex did not affect the mean ROE and NOSE scores. Thus, increased patient
satisfaction measured by the ROE is present in both sexes and at both age groups but
it is better detected in the first year after surgery. Functional improvements analyzed
with NOSE are best detected in patients aged ≥ 30 years and in follow-ups of 11 months.
The caudal extension graft of the LLC technique described herein effectively and safely
corrects alar retraction and the collapse of the nasal valve while filling the soft
triangle.
Keywords
rhinoplasty - nasal cartilages - quality of life - nasal obstruction
