Single-Stage Alar Nostril Ring Correction Using Auricular Composite Grafts in Reconstructive Rhinoplasty.

Abstract

Alar nostril ring correction in patients with multiple prior surgeries is one of the most challenging procedures in reconstructive rhinoplasty. Assessing patient satisfaction and the technique's failure rate is essential in evaluating its effectiveness. This study aimed to assess the outcomes of alar nostril ring correction using auricular composite grafts (ACGs) in patients with severe post-rhinoplasty deformities from multiple previous surgeries. A retrospective review of medical records from April 2016 to October 2023 was conducted. Patient demographics, surgical techniques, and functional/aesthetic outcomes were analyzed. Patient satisfaction was measured using the Obstruction and Cosmesis scores from the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). A total of 45 cases (38 female and 7 male) aged 36.4 ± 7.64 years underwent alar nostril ring correction using ACGs from the antihelix, with an average of 2 prior rhinoplasties. Preoperative SCHNOS-O and SCHNOS-C scores were 88.44 (SD =14.41) and 88.30 (SD =12.44), respectively. ACGs' shape was like parabolic cylinders, with arc lengths between 15-21 mm and flat dimensions of 6-9 mm by 3-7 mm. No graft failures were observed, even in 10 patients with a history of nasal skin necrosis. Postoperative SCHNOS-O and SCHNOS-C scores after 1 year were 35.44 (SD =21.07) and 35.85 (SD =19.04), representing significant improvement (P < 0.001). ACGs from the antihelix effectively address external valve stenosis due to aggressive alar-sill junction tissue resection in reconstructive rhinoplasty, even in complex cases.