Alar Retraction Research Articles

Corrigendum to: Alar rim composite graft: a safe and simple way to correct alar retraction

Corrigendum to: Alar rim composite graft: a safe and simple way to correct alar retraction

Correction and prevention of tip asymmetries, bossae, and alar retraction

Secondary rhinoplasty to address complications from initial surgical intervention is a technically challenging operation. Common aesthetic complications that plague patients after primary rhinoplasty include nasal tip asymmetries, bossae, and alar retraction. These adverse outcomes are usually a result of over-manipulation and/or over-excision of native cartilage and are especially prevalent in patients with thick lower lateral cartilages and thin nasal skin. Techniques to minimize tissue handling, maintain natural nasal anatomic support and structure, and soften sharp edges from cartilage grafts or incisions are all essential in the prevention of nasal tip irregularities. In addition to prevention, there are many operative and procedural interventions to correct tip asymmetries, bossae, and alar retraction. These interventional corrections include varying cartilage and/or fascial grafts, camouflaging of previously performed grafts, and repositioning of the alar cartilage.

ALAR BASE LINING GRAFT (ABLG): A NEW TECHNIQUE TO PREVENT AND CORRECT ALAR RETRACTION IN PRIMARY AND SECONDARY RHINOPLASTY.

rhinoplasty traditionally represents a difficult challenge for plastic surgeons. The aim of this article is to describe our personal new graft ABLG (Alar base lining graft) in augmentation rhinoplasty, to treat and prevent alar retraction. in this study, we retrospectively reviewed patients treated with ABLG at our institution between July 2019 and April 2022. We described our personal technique and graft. At a minimum follow-up time of one year, post-operative pictures were taken, and patients were reassessed, evaluating aspects such as global symmetry, shape and contour of the nose, Finally, patients' satisfaction was investigated according to ROE questionnaire. a total of 42 patients were included in the study. They reported a significant satisfactory aesthetic result in nasal image, as the mean postoperative ROE score shows. The alar contracture in secondary rhinoplasty was successfully treated. None of the grafts was extruded or collapsed. Wounds healed without reported major infection. this study has demonstrated that ABLG is a safe graft that contributes to improved functional and aesthetic outcomes, has a high patient satisfaction rate, and a low rate of post- operative complication.

Lateral Overlay Sliding Transposition (LOST): A Novel Surgical Technique in Patients with Cephalic Malposition and Alar Retraction.

This study aims to demonstrate a new surgical technique that can be applied in patients with cephalic malposition and patients with alar retraction. In this technique, a cartilage incision is made between the upper 2/3 and lower 1/3 close to the caudal edge and parallel to the cephalic edge of the lateral crus. Following this incision, the cephalic lateral crus and middle crus are meticulously dissected away from the underlying vestibular skin. The prepared flap is transposed over the intact caudal part of the lateral crus and secured in position. The average age of the patients included in the study was 24years. The mean follow-up period was nine months, ranging from 6 to 12months. No complications were observed following the application of the technique. Satisfactory outcomes were achieved postoperatively. Lateral overlay sliding transposition as a novel surgical technique has been demonstrated in patients presenting with cephalic malposition, mild to moderate alar retraction, and alar irregularity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Application of Auricular Cartilage-Skin Graft in the Reconstruction of Unilateral Cleft Lip Nasal Deformity.

Autologous cartilage grafts are increasingly used in the treatment of cleft lip nasal deformity, but nasal alar retraction caused by lining defects often occurs after surgery. We designed a new graft to treat unilateral cleft lip nasal deformity while avoiding nasal alar retraction. Nineteen patients in our hospital underwent unilateral cleft lip nasal deformity repair surgery with an auricular cartilage-skin graft. The effect of surgery was evaluated in four aspects: satisfaction with postoperative appearance, nasal aesthetic subunit indices, position of the nasal alar rim and three-dimensional spatial difference. Overall satisfaction with each index was above 90%. The nasal tip angle and nasolabial angle of patients were significantly smaller after surgery than before surgery (P < 0.01). The height of the nostril on the affected side and the length of the nasal columella were greater after surgery than before surgery (P < 0.01). The spatial differences in soft tissue between the unaffected side and the affected side after surgery were significantly smaller than before surgery (P < 0.01). According to the follow-up results of 1-2 years, there were no significant retraction of the nasal alar rim (P > 0.05) and no obvious auricular deformity. All patients had a noticeable improvement in their nasal appearance. The auricular cartilage-skin graft, which can not only improve the appearance of the nose but also avoid nasal alar retraction, is an ideal graft to cure unilateral cleft lip nasal deformity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

External Z-plasty Technique for Correction of Alar Retraction in Asian Patients.

Current strategies for correcting alar retraction mainly include cartilage grafting and composite grafting, which are relatively complicated and may produce injury to the donor site. Herein, we introduce a simple and effective external Z-plasty technique for correcting alar retraction in Asian patients with poor skin malleability. Twenty-three patients were presented with alar retraction and poor skin malleability, and they were very concerned about the shape of the nose. These patients undergoing external Z-plasty surgery were analyzed retrospectively. In this surgery, no grafts were needed, and the location of the Z-plasty was according to the highest point of the retracted alar rim. We reviewed the clinical medical notes and photographs. During the postoperative follow-up period, patients' reported satisfaction with aesthetic outcome were also evaluated. The alar retraction of all the patients was successfully corrected. The postoperative mean follow-up period was 8 months (range: 5-28mo). No incidents of flap loss, recurrence of alar retraction, or nasal obstruction were observed during postoperative follow-up. Within postoperative 3-8 weeks, minor red scarring was visible at the operative incisions in most patients. However, these scars turned unobvious after postoperative 6 months. There were 15 cases (15/23) being very satisfied with the aesthetic outcome of this procedure. Seven patients (7/23) were satisfied with the effect and the invisible scar of this operation. Only one patient was dissatisfied with the scar, but she was satisfied with the correction effect of the retraction. This external Z-plasty technique can be an alternative method for correction of alar retraction with no need of cartilage grafting, and the scar can be unobvious with fine surgical suture. However, the indications should be limited in patients with severe alar retraction and poor skin malleability, who should not particularly care about the scars.

Modified trilobed transposition flap for a distal nasal defect.

Reconstruction of a distal nasal defect is challenging due to poor skin mobility and the potential for nasal alar retraction. A trilobed flap can utilize more mobile proximal skin, increase the total rotational arc, and decrease the tension associated with flap transposition. However, the trilobed flap may not be ideal for distal nasal defects because each flap is designed using immobile skin, which may lead to flap immobility and free margin distortion. To overcome these problems, the base and tip of each flap were extended further from the pivot point than those of the conventional trilobed flap. Herein, we report the use of the modified trilobed flap to treat 15 consecutive cases of distal nasal defects that occurred from January 2013 to December 2019. The mean duration of follow-up was 15.6 months. All flaps survived completely, and satisfactory aesthetic outcomes were achieved. No complications such as wound dehiscence, nasal asymmetry, or hypertrophic scarring were observed. The modified trilobed flap is a simple and reliable treatment for distal nasal defects.

External rhinoplasty based on the classification of alar retraction associating with exposure of the nostrils

Objective: To introduce a classification of alar retraction, and to discuss the therapeutic strategy of alar retraction with cartilage graft and the satisfaction evaluation of patients after operation. Methods: A retrospective analysis was performed on 88 patients with alar retraction admitted to the Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital of Central South University from January 2015 to December 2020, including 20 males and 68 females, aged 20 to 48 years, with an average age of 28.98 years. All patients underwent external rhinoplasty according to a series of treatment plans determined by the classification of alar retraction based on nostril exposure. Visual Analogue Scale (VAS) and Rhinoplasty Outcomes Evaluation (ROE) were used to conduct satisfaction survey before and 12 months after operation. Wilcoxon signed-rank test was used to analyze patient satisfaction. Results: A total of 88 patients were included in this study. According to the classification of alar retraction based on nostril exposure, 45 cases were mild, 23 cases were moderate, and 20 cases were severe. There were 16 cases of unilateral and 72 cases of bilateral alar retraction. The patients were followed up for 12 to 18 months, with an average of 13.37 months. The VAS score and ROE score after each type of surgery were higher than those before surgery, with statistically significant (all P<0.05). Among them, the difference in VAS score (6.75±1.29) and in ROE satisfaction (67.70±7.38) of patients with severe alar retraction were the most significant improvement. Conclusion: The classification of alar retraction based on nostril exposure in the frontal view can comprehensively evaluate the severity of alar retraction, and makes the treatment algorithms systematic and comprehensive. The satisfaction of patients is relatively high.

Oblique Dome Division Technique/ Preservation Rhinoplasty

Open rhinoplasty techniques as well endonasal techniques that involve lower lateral cartilage delivery and marginal incisions lead to many unpleasant effects such as alar notching, alar retraction, alar collapse, dropped/pinched tip, Pollybeak, asymmetry, alar collapse, deviation, and dimpling. Both the original Joseph endonasal technique and the later Goldman endonasal tip technique has also resulted in the above issues, while these problems are well documented in the open rhinoplasty approach. To reduce these sequalae, the author has developed a new combination technique. It is based on the Goldman's tip and the I-beam of intermediate crura while avoiding lateral crus marginal incision and delivery (which are the culprits associated with a poor outcome). This results in an intact alar rim reducing healing problems along the alar rim. Furthermore, lateral crus preservation together with a strong tripod of conjoined lateral to medial crura supported by a columellar strut and tip grafts lead to significantly enhanced tip support thus substantially reducing negative sequalae such as asymmetry, alar collapse, dropped tip, pinching, notching and alar retraction while at the same time making the outcome more predictable. The author has been applying this technique since 1999 (Last 23 years). The technique and follow-up will be fully discussed.

A novel classification of alar retraction based on nostril exposure in Asian rhinoplasty

ObjectiveAlar retraction is considered a challenge in rhinoplasty. The classification of alar retraction remains poorly defined, especially in Asia. Patients with alar retraction are associated with excessive exposure to the nostrils in Asia. This study aimed to introduce a classification method of alar retraction based on nostril exposure. Materials and methodsMedical records of patients who had undergone rhinoplasty with alar retraction based on nostril exposure between January 2015 and December 2020 were retrospectively reviewed. The corrections of alar retraction were categorized into three groups according to a classification method of alar retraction based on nostril exposure: mild alar retraction, moderate alar retraction, and severe alar retraction. The visual analog scale (VAS) and rhinoplasty outcomes evaluation (ROE) were used to evaluate the satisfaction rate. ResultsWithin a median period of 13.3 months, 45 patients (51.14%) with mild alar retraction were corrected by alar contour graft. 23 patients (26.14%) with moderate alar retraction were treated with the alar contour graft(n=10), the lateral crural strut graft (n = 6), and the alar projection graft (n = 7). 20 patients (22.73%) with severe alar retraction were corrected by lateral crural strut graft combined with composite graft (n = 6), lateral crural strut graft (n = 10), and composite graft (n = 4). The severe alar retraction group had a higher satisfaction rate in ROE(P<0.05) and VAS (P<0.05) than moderate alar retraction and mild alar retraction at a follow-up of 12 months after surgery. ConclusionsThe classification of alar retraction based on nostril exposure is more practical for rhinoplasty in Asia.

Frequency, Indications and Intraoperative Dynamics of Repositioning of the Lateral Crura of the Lower Lateral Cartilage: A 35-Year Experience.

Lower lateral cartilage repositioning (LLCR) is an effective technique that places the lateral crus in a newly created caudal pocket, and is utilized for a variety of indications including cephalic malposition, alar asymmetries and tip rotation/projection alteration. However, there is a relative sparsity in the literature regarding this procedure and the dynamic changes that it produces. In this study, we report our experience with LLCR in regard to its indications and related interplays. Data from our institution were collected from the most recent 100 primary rhinoplasties, most recent 100 secondary rhinoplasties and all LLCRs performed. For each LLCR, patient demographics and concurrent surgical techniques were compiled. A descriptive analysis was performed for all cohorts, while Fischer's exact test was performed to compare the associations of categorical data for the respective sample sizes of the primary and secondary rhinoplasty cohorts. Overall, 127 patients underwent LLCR, with eleven (11%) LLCRs in the primary rhinoplasty cohort and twelve (12%) LLCRs in the secondary rhinoplasty cohort. The most common indication for LLCR was cephalic malposition, followed by over-projection and asymmetry of the lower lateral cartilages. Intraoperative observation of dynamic changes included invariable cephalic rotation of the tip, ability to precisely control the tip projection, drastic narrowing of the domal arch often minimizing the need for the transdomal suture, alar repositioning caudally, correction of alar retraction and more elegant tip definition. However, the external valve lost its strength on majority of LLCR patients, which required almost routine use of Gunter lateral crus strut. LLCR is a powerful and versatile tool that can be utilized in either primary or secondary rhinoplasty. Its transposition results in cephalic rotation of the tip, narrowing of the domal arch, caudal reposition of the alar rim and superior tip definition. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Correction of the Nasal Ala

The alar-columellar relationship is an important concept for the rhinoplasty surgeon to master. The alar rim in particular is a critical component of the nasal tip, contributing to both overall symmetry and proportion of the nasal base. The retracted ala creates a displeasing aesthetic to the tip complex, distorts the nostril openings, and may have functional implications of the external nasal valve. While alar retraction can occur naturally or as the result of trauma, the majority of cases are post-surgical in nature. Many techniques have been described for correction of alar retraction, most of which require open rhinoplasty and many fail to add the soft tissue within the vestibule necessary to properly lower the alar margin. Herein, we present our experience with the auricular chondrocutaneous composite graft-a simple, reliable, and effective technique to correct moderate to severe alar retraction via either open or endonasal rhinoplasty.

Rinoplasti Ameliyatında Lateral Krus Malpozisyonu ve Alar Rim Retraksiyonunun Simültane Düzeltilmesi: Kaudale Uzatılmış Lateral Krus Strut Grefti

Objective: Cephalic malposition and weakness of the lateral crus may result in a long alar line, boxy nasal tip, parenthesis-deformity of the alar rim and external nasal valve insufficiency in deep inspiration, in addition to alar retraction. There is no gold standard method for correcting alar retraction and lateral crus deformities in rhinoplasty operations. Caudal extended lateral crural strut (CELCS) graft is a technique used to correct malposition of the lateral crus, to strengthen a weak lateral crus and to correct the alar rim retraction. An autologous septal cartilage graft may be used during CELCS. Methods: CELCS graft was placed in 46 primary, open rhinoplasty procedures between 2014 and 2019. The graft was harvested from septal cartilage and placed on the lateral crus so that the cephalic areas overlapped while the caudal portion would extend into the pocket created in the caudal rim. Results: Of the 46 patients, 30 (65.2%) were female and 16 (34.8%) were male. Median (range) age was 32 (23 to 41) years. All patients underwent CELCS graft, placed to correction cephalic malposition and alar rim retraction simultaneously. The average follow-up period was 12 months (9-15 months). Satisfactory results were achieved in all patients. Conclusion: CELCS graft was a successful method to correct both lateral crus malposition and alar rim retraction simultaneously.

The Onlay Rotated Flap (ORF): An Original Technique for Nasal Tip Plasty.

The reshaping of the nasal tip in rhinoplasty according to the expectations of the patient and the surgeon is called tip plasty. in this article, the onlay rotated flap (ORF) is presented as a new technique for reshaping, supporting, and projecting the nasal tip without any resection or grafting. Thirty-two patients (26 female and 6 male) were included in the study retrospectively. Primary rhinoplasty with ORF was performed to all patients. The follow-up period was between 9 and 12months. The nasal tip projection (NTP) with Goode method and nasal tip rotation (NTR) according to nasolabial angle were calculated in standardized preoperative and postoperative(6th month) photographs with image J. SPSS Version 21.0 was used for statistical analysis. There were no complications resulting from our procedure. There were no visible tip flaps, no distortion, no asymmetry, and no alar retraction. Revision surgery was not required in any patient. The preoperative and postoperative means of nasolabial angle (Mean ± SD) were 92.06 ± 7.73° and 99.71 ± 6.06°, respectively. The preoperative and postoperative means of NTP (Mean ± SD) were 0.535 ± 0.041 and 0.57 ± 0.386, respectively. The postoperative nasal tip rotation and NTP values of the ORF procedure were found to be statistically significantly higher than the preoperative values (P < 0.05). The ORF technique is another alternative for achieving adequate nasal tip definition and projection and has many advantages and very successful postoperative results. The alar retraction was not encountered in our technique and this is the superior aspect of our technique over similar methods described in the literature.

A comprehensive analysis of the correction of alar retraction in rhinoplasty: A systematic review

Alar retraction, as a type of alar deformity, seriously affects the esthetic perception of the nose in patients. Despite the rapid development of rhinoplasty in recent years, the treatment of alar retraction is still a challenge work in plastic surgery. This systematic review highlights the etiology, treatment, and prevention of alar retraction to further guide practitioners. A systematic review was conducted from 1975 to 2020 through PubMed, Embase, Web of Science, and Cochrane database with the key words "alar retraction" and "rhinoplasty" or "Rhinoplasties" to investigate the surgical treatment of alar retraction. The inclusion and exclusion criteria were set to screen the literature. A total of 163 literatures were obtained through database retrieval. After removing the duplicate literature, reading the title and abstract, and reviewing the full text finally, 34 articles were included in the final study. Most of the articles have summarized the surgical methods to correct alar retraction by retrospective study. Alar retraction should be analyzed from the etiology, pathogenesis, and treatment. The diversity of surgical methods provides more options for the clinic. However, the plastic surgeons need to develop sharp analytical skills, improve clinical operational capability, and look for appropriate methods to achieve in good result.

Alar Rim Triangular Flap for Congenital Nasal Cleft Repair in Pediatric Patients.

According to Tessier classification, number 1 and number 2 craniofacial clefts involve the nasal ala. Congenital nasal cleft is not common and is difficult for reconstruction. Notches in the medial one-third of either nasal ala are typical manifestations in these patients. Herein, we introduce a alar rim triangular flap, which is indeed a local flap, for the treatment of isolated nasal cleft due to congenital deformities in pediatric patients. The authors conducted a retrospective cohort study including 10 consecutive pediatric patients undergoing this surgery. This alar rim triangular flap including 2 triangles was existing nasal tissue near the cleft. The alar rim defect was covered through local tissue re-arrangement. The authors reviewed the photographs and clinical medical notes of these patients carefully. Self-reported satisfactions of patients (or children's parents) with the scar morphology and correction effect of this procedure were evaluated as well at postoperative every follow-up. All the cases were followed up regularly, and the average follow-up time was 22 months (ranged from 13-38 months). All the nasal clefts were reconstructed successfully. The alar rim triangular flap survived with no flap loss. The wound created by this procedure healed primarily. No alar retraction, nasal obstruction or step-off deformities were observed during postoperative follow-up. There were no patients unsatisfied with the outcome of the scar morphology and correction effect of this operation. The newly designed alar rim triangular flap in this study can be an alternative treatment for correcting isolated congenital nasal cleft with optimal clinical outcome. Level 4.

Designing a Trifoliate Flap for Isolated Congenital Alar Rim Defect in Pediatric Patients.

Isolated congenital alar rim defects are extremely rare, and there has been no standard technique for the reconstruction of remarkable aesthetic deformity. Herein, we introduce a trifoliate flap for the correction of isolated congenital alar rim defects in pediatric patients. Fifteen cases undergoing nasal alar sulcus rotation flap surgery were analyzed retrospectively. This rotation flap including 3 triangles was a modified flap based on prior studies. Clinical medical notes and photographs were reviewed. Patients' (or their parents) reported satisfactions with aesthetic outcome were also evaluated during the post-operative follow-up period. In all patients, the isolated congenital alar rim defects were successfully reconstructed. The rotation flap survived and the wound healed primarily. The follow-up period ranged from 6 to 22 months (average 11 months). There were no incidents of flap loss, step-off deformities, nasal obstruction, or alar retraction. At follow-up of post-operative 3 months, pale red scars were observed in the operative area in few patients (2/15). However, these scars gradually became invisible at post-operative 6 months. All patients (or their parents) were satisfied with the aesthetic outcome of this operation. This newly designed trifoliate flap can be an alternative method for the reconstruction of isolated congenital alar rim defects in pediatric patients. The scars of this procedure can be unobvious with fine surgical suture.

Is reconstruction of composite defects of nose and cheek following tumor excision utilizing subunit principle the best?

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Composite defects of nose and cheek are best stage reconstructed with separate nose and cheek flaps to recreate a blended nose-cheek junction, achieved by cheek advancement flap for cheek and forehead flap or local grafts for the nasal defect. This article analyses whether reconstruction of defects utilizing well-known subunit principle is cosmetically the best?&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Case records of fifteen patients of nasal cancers extension into the cheek from January 2011 to December 2015 were analyzed retrospectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of fifteen patients 8 were men and 7 women, two patients had SCC, rest had BCC. Average size of defect was 4.5 cm. Modified Imre’s cheek advancement flaps was used in all to reconstruct cheek defects while paramedian forehead flap was used for nasal reconstruction in 13 patients, skin graft and nasal advancement flap in one each. Eight patients underwent single stage reconstruction while seven with full thickness nasal defects had a delayed reconstruction. 13 patients rated their final appearance as satisfactory, while surgeon rated 12 patients with well-blended nose-cheek junction as satisfactory and lateral migration of junction being unsatisfactory. Alar retraction was observed in two patients with full thickness nasal defects. Two patients who underwent inner nasal lining reconstruction developed wound dehiscence while simultaneous reconstruction of nose and cheek was performed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Subunit principle application for composite nose and cheek results in symmetrical nose-cheek junction and appears excellent technique in achieving a satisfactory aesthetic outcome. Optimal results in full thickness nasal defects are achieved where reconstructing is delayed.&lt;/p&gt;

Caudal Extension Graft of the Lower Lateral Cartilage: Technique and Aesthetic and Functional Results.

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.

Nasal alar rim redraping method to prevent alar retraction in rhinoplasty for Asian men: A retrospective case series.

BackgroundFor an attractive and natural tip contour in Asian rhinoplasty, insertion of a nasal implant and reinforcement of the cartilaginous framework are essential. However, scar contracture, which often results from augmentation with implant insertion and inadequate soft tissue coverage of the framework, is one of the most common causes of alar retraction. This study reports a novel method of redraping soft tissue along the alar rim to prevent alar retraction in Asians.MethodsTwenty young Asian men who underwent primary rhinoplasty with septoplasty were retrospectively reviewed. After the usual rhinoplasty procedures, alar rim redraping was conducted for the soft tissue along the transcolumellar and bilateral infracartilaginous incisions. The longest axis of the nostril (a) and the height of the nostril from that axis (b) were measured in anterior-posterior and lateral views. The preoperative and postoperative ratios (b/a) were analyzed using the paired t-test.ResultsAll 20 patients showed natural contours of the nasal tip, nostrils, and alae after a mean follow-up of 53.6 weeks (range, 52–60 weeks). The ratio of the nostril axes significantly decreased postoperatively in all patients except one, by an average of 11.08%±6.52% in the anterior-posterior view and 17.74%±8.49% in the lateral view (P<0.01). There were no complications, including asymmetry, contracture, subdermal plexus injury, flap congestion, or infection.ConclusionsA quantitative analysis of alar retraction by evaluating the ratio of nostril axes showed that alar rim redraping is a simple and effective adjuvant technique for preventing alar retraction in rhinoplasty for young Asian men.