Alar Spreader Grafts Still Used to Correct Nasal Pinch and Alar Collapse?

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.

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

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).

Dear MissLouise,

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.

Best,

Nima Shemirani

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.