I am researching revision rhinoplasty and want to make sure I have the correct procedure done to fix my pinched tip, noticeable alar creases and breathing problem. My original nose had a wide nasal tip, no hump. Tip has been reduced too much. Am I correct and is this problem called "external valve collapse"? I found two techniques to fix this: 1) alar batten grafts 2) (older technique?) alar spreader grafts (see pic). Which one is the best to correct my problem?
Alar Spreader Grafts Still Used to Correct Nasal Pinch and Alar Collapse?
Doctor Answers 8
Battens vs. Alar Spreaders
Unfortunately, your problem occurs fairly often when too much cartilage is removed from the nasal tip. The result is pinching of the nasal tip and collapse of the nostrils with breathing. Many, many rhinoplasty maneuvers have been described for correcting nose problems throughout the years. Most of these have come and gone with the times, others have become standards.
To treat your problem, alar batten grafts and lateral crural strut grafts are much more commonly used than are alar spreader grafts.
- Alar Batten Grafts: these cartilage grafts begin at the lateral crura and end over the bone of the cheek at the base of the nose.
- Lateral Crural Struts: these grafts are placed under the nasal tip cartilage (lateral crura) and do not touch the cheek bone
I have used alar batten grafts in 35% of my last 300 rhinoplasties and have never performed alar spreader grafts. However, if you find a surgeon who uses and is comfortable with alar spreader grafts, there is no reason that you wouldn't enjoy a great result. What is most important is what the surgeon feels comfortable doing.
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Best method to correct tip pinching
You appear to have cephalically positioned lower lateral crura. In situations like this where there is tip pinching and collapse I find that strengthening and repositioning the lower lateral cartilage is a much more powerful technique than alar batten grafting or alar spreader grafts.
This lower latreal crural strut grafting improves the dynamics of the area by creating a stronger external valve. At the same time the lower lateral cartilages (with their strut) can be relocated so that they bring down the nostril margin to improve alar retraction and create more natural tip highlights and shadows.
This technique is relatively specialized and not all rhinoplasty surgeons perform it (or have heard of it).
Cephalic Oriented Lower Lateral Cartilage
Cephalically-oriented lower lateral cartilage is a very common ethic variation and can be a trap for lateral collapse after a "routine" rhinoplasty. This usually ends up with the "parentheses deformity" where too much lower lateral cartilage was removed or lateral support was not added during the primary procedure. Alar retraction or notching is also commonly associated with these patients. I don't think the "alar spreader" graft is a commonly accepted technique for correction of this problem. The lateral crural strut, on the other hand, is designed to reinforce this weak lateral cartilage - thus providing for better breathing, contour and correct alar retraction. I have used both lateral crural struts and alar "batton" graphs to correct these problems.
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Revision rhinoplasty for a pinched tip
It is great that you are doing a lot of research before your procedure. That way, you can have an educated conversation with you plastic surgeon regarding revision rhinoplasty. There are several issues that can lead to problems breathing including a deviated septum, enlarged turbinates (soft tissue covered bone inside your nose), external nasal valve collapse (where the nostrils, at their base, collapse when you breathe in), and internal nasal valve collapse (where the pinched areas collapse when you breathe in). You should have a thorough exam by a rhinoplasty specialist who can help guide you in your decisions. I would also recommend getting more than one opinion.
Correcting nasal pinching and collapse
There are a number of good options for correction of pinching and collapse - the best options depends on whether your breathing is also compromised - some of the techniques are more cosmetic while other also improve breathing
Spreader grafts and alar batten grafts
Spreader grafts are used to cosmetically straighten the concavity on the outside of the nose. They are also used to improve airflow dynamics through the nose when there is vestibular collapse on the internal portion of the nose usually on that concaved side. Alar batten grafts are used to correct asymmetrical alar rim collapse. It is important to research and find a very experienced rhinoplasty surgeon prior to embarking on this endeavor. Look for a surgeon who has performed thousands of rhinoplasties and he or she will have performed thousands of these types of grafts as well.
Correction of Nasal Pinch and Alar Collapse
Rather than trying to determine the best technique to improve your result, spend your time finding the best revision rhinoplasty surgeon that you can. There is no 1 right way to meet your objectives.
Spreader grafts add significant width to the nasal tip
There appear to be some cartilage irregularities in the area above the nasal tip and the left tip cartilage has an indentation but I do not see the need to use a spreader graft. Spreader grafts are for indentations along the internal nasal valve (middle of the nose just behind the nasal tip) which does not appear on the photo provided.
Spreader grafts add significant width to the nasal tip, which would not be an aesthetic improvement to your nose IMHO. I would perform aretrograde closed tip plasty to create more symmetry of the nasal tip and then adjust the supratip area for a more smooth and even nasal external appearance.
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