What is the Difference Between Alar Rim Graft and Alar Batten Graft?

Question

I am going in for a revision rhinoplasty. I have a pinch tip as well as underprojected tip.   I am wondering if an improvement in the projection of my nose also aids in the straightening of the alar rim, subsequently improving the pinched tip look? (Giving a more triangular shape on basal view).   Also, what is the difference in usage between the alar rim graft and the alar batten graft? Thank you

Scott Trimas, MD · Answer

Overly pinched nasal ala need to be corrected by supporting the ala back toward its normal convex shape. It may also involve lengthening or stretching the ala downward. In both of these cases an alar batten graft is useful. An alar rim graft specifically addresses notching of the ala or retraction of the ala from removing too much marginal tissue. This is placed at the end of the existing alar cartilage along the nostril rims to stretch the skin downward. Finally, sometimes lateral crural grafts are needed as well to add rigidity back to the alar regions to support it from collapsing and they go underneath the existing alar cartilages to give it strength like a brace. I hope this information helps.

Eric M. Joseph, MD · Answer

You would be surprised how much improvement you could see in your nose with an Injectable Filler treatment. Non-Surgical Rhinoplasty is not right for all nasal irregularities, but it does work well for improving a pinched tip, and for lowering retracted nostrils.
You should consult a board-certified Rhinoplasty specialist familliar with the art of using fillers in the nose. You should see many photos before you proceed.
Alar batten grafts are used to correct a pinched tip, and alar rim grafts are used to lower retracted nostrils. In my personal experience, Silikon-1000 works well for both of these conditions. All without the expense, inconvenience, risk and downtime associated with Revision Rhinoplasty Surgery.
I hope you find this helpful.

Otto Joseph Placik, MD · Answer

The alar rim is placed along the rim of the ala (nostril) and is used to reinforce the soft triangle and minimize alar notching. The alar batten acutally goes into the bulk of the nostril and on the basal view helps to achieve the triangular appearance you desire. It alos helps to prevent inspiratory collapse which is inward drawing of the nostrils with a deep breath.

William Portuese, MD · Answer

An alar batten graft is a cartilaginous graft usually composed of septal cartilage that is placed in the pyriform aperture and inserted underneath the lower lateral cartilage to bolster a weak lower lateral cartilage.
An alar rim graft is a small sliver of cartilage placed literally at the nostril rim to prevent a notched rim.  Both grafts are used to prevent collapsing, especially upon inspiration and breathing.
Neither one of these grafts will increase the projection of the tip itself.  An alar batten graft will help with a pinched nasal tip by giving it some whiff.  Adding projection to the nose will not straighten the alar rim if there is weak and flail cartilages.

Samir Shureih, MD · Answer

If your surgeon discussed these grafts with you, he knows advanced rhinoplasty.
Discuss the reaso for the graft, what is he trying to correct or prevent. whare the graft is coming from.
If you have a notched ala you need an alar rim graft to lengthen and strengthen the ala and the internal valve.
 If you already have an internal valve collapse you need a batten graft to support the ala and the internal valve

Darryl J. Blinski, MD · Answer

Very specific question in advanced rhinoplasty techniques. The previous posters answers are correct and very informative. But for the patient you should be asking these questions to your operative surgeon as part of your informed consent. Also you should discuss the exact graft and why with him. We, as expert posters, can only give detailed medical/scientific information that could relate to your own personal issues. Take our posted information to the operative surgeon and try to receive a better understanding of these terms and advanced techniques. Best of Luck. 
From MIAMI Dr. B

Peter A. Aldea, MD · Answer

Agree completely with Dr. Placik's summary. Alar rim graft are extra-anatomic grafts used to correct nasal rim notching in revision cases. On the other hand, alar batten grafts are used to provide strength to the remaining cartilage arch support of the nostril and prevent collapse on inspiration. Increasing the projection of your nose would probably require a columellar strut graft while the pinched tip look may be corrected with placement of a tip graft.

Richard W. Fleming, MD (retired) · Answer

Alar rim grafts are usually placed above the edge of the nostril just below the lower margin of the lateral tip cartilages to prevent or correct retraction of the alar rim. Depending on the particular needs of each patient, these grats are fahioned from cartilage, or skin and cartilage. Alar batten grafts are placed over the lateral tip cartilages to strengthen these cartilages and restore their normal slightly convex contour. Grafts to increase tip projection are placed at the center if your tip. I hope this helps you understand a very complex topic re rhinoplasty surgery.

Edward J. Domanskis, MD (in memoriam) · Answer

Grafts are used to build up areas or change them like straighten them. They can either be from the septum, ear, rib. One placed in the alar rim will straighten that area and may help the projection. Evaluating what you have and what concerns you will determine what can be done and how.

What is the Difference Between Alar Rim Graft and Alar Batten Graft?

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