Postsurgical Alar Retraction : Etiology and Treatment - 03/10/19

Doi : 10.1016/j.fsc.2019.07.006

Wee Tin K. Kao, MD ^a, Richard E. Davis, MD ^b,^c,^⁎
^a Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, 5th Floor, Miami, FL 33136, USA
^b Facial Plastic and Reconstructive Surgery Fellowship, The University of Miami Miller School of Medicine, Miami, FL, USA
^c The Center for Facial Restoration, 1951 Southwest 172nd Avenue, Suite 205, Miramar, FL 33029, USA

^∗Corresponding author. The Center for Facial Restoration, 1951 Southwest 172nd Avenue, Suite 205, Miramar, FL 33029.The Center for Facial Restoration1951 Southwest 172nd AvenueSuite 205MiramarFL33029

Résumé

The cephalic trim technique is a popular maneuver that often leads to tip deformities, most notably postsurgical alar retraction (PSAR). We advocate using the external rhinoplasty approach to correct PSAR by (1) releasing and repositioning the retracted alar margin, (2) strengthening and immobilizing the central tip complex using a septal extension graft, (3) suspending and longitudinally tightening the mobilized lateral crural remnant by adjusting crural length to match the sidewall span, and (4) providing direct skeletal support to the repositioned alar margin using articulated alar rim grafts. Using this structural treatment paradigm, we have corrected severe PSAR in the preponderance of secondary rhinoplasty cases.

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Keywords : Rhinoplasty, Post-rhinoplasty complications, Post-surgical alar retraction, Pinched tip, Alar notching, Articulated alar rim graft