What is the difference between alar batten grafts and lateral crural strut grafts? Which is better for correcting a pinched tip?

Question

Alejandro Nogueira, MD · Answer

Batten grafts: their purpose is to correct pinched noses and collapsed nasal valves, normally after supoptimal or faulty rhinoplasties or also postraumatic cases; this is a widespread technique and very useful in secondary rhinoplasties.Strut grafts: their goal is to flatten and straighten and lateral pillars of the lower lateral crura; additionally they may have the effect to increase resistance of the non-operated and not damaged nasal valve when it collapses with strong voluntary inspiration; this technique is actually an oddity without, in my opinion, practical use; it is not a technice specially designed for secondary rhinoplasties or pinched noses; being true that it reinforces the strenght of the virgin nasal valve, I don't think it is an indication as general purpose surgical gesture neither as method to flatten or change the shape of the lateral pillars of the lower lateral crura.Keep in mind that a pinched tip may be produced by an over-resection of alar cartilages, in which case you need a replacement graft to substitute the whole lateral crura; this is sometimes the best solution instead of unfeasible useless refinements which work only in theories and technical drawings but not in real knife-to-flesh surgical action.Anyhow, information and awareness is always good, but patients should never try to learn plastic surgery in order to design their procedure, you must indeed find the best expert in revision rhinoplasties for your case; this professional will study your situation and plan an strategy for your nose, plan that normally is modified to adapt it to the intraoperative findings. I can tell you by my own experience doing personally hundreds of secondary rhinoplasties that finding unexpected issues is the rule during each revisional nose I carry out.

Thomas J. Walker, MD, FACS · Answer

This is an extremely complicated question. I would advise you see a surgeon who utilizes all possible techniques and have him/her decide which technique is best for you. Instead of focusing on the technique utilized, it is better to pay attention to the functional and aesthetic goals and leave it to the surgeon which grafting technique is best for you. I frequently use both (LCSGs and alar batten grafts) in the same patient, especially when placing lateral crural strut grafts with caudal repositioning. Alar batten grafts support the internal nasal valve in such cases and prevent subsequent supra-alar pinching in the void created through repositioning. Frequently, these decisions are made intraoperatively. Cartilage availability is often a limiting factor and it is good to have a surgeon who has a wide armamentarium of surgical techniques including septoplasty (always the preferred donor site for cartilage if sufficiently available), ear cartilage grafting, and rib cartilage grafting. At your consultation, your surgeon should discuss with you what the likelihood is of requiring either ear or rib cartilage. In primary rhinoplasty, it is rather rare that either one is needed. The septum is usually sufficient. Rather than talking about which grafts are placed, I believe it is more important to think about and discuss where the grafts might possibly be coming from. Please also remember that is not only the technique utilized to get a given result, but also the proficiency of the surgeon with a given technique. Lateral crural strut grafts, while leading to excellent results if properly performed, come at a higher risk of unwanted results if not done properly. Surgeon experience is critical and you should see someone who performs rhinoplasty on a regular basis. Good luck!

Jon E. Mendelsohn, MD, FACS · Answer

Alar Batten Strut grafts are most likely one of the solutions for your rhinoplasty, specifically your pinched nasal tip.  However, depending upon what you are classifying as a "pinched" tip, and on how your nasal anatomy appears, other nasal grafts may be required to improve the nasal appearance.  I do not see a photo attached to your  post here, but various grafts may be needed correct your concerns.

Toby Mayer, MD · Answer

Alar batten grafts are what you need for the pinched tip. See a very experienced revision rhinoplasty surgeon for this whose work looks natural. Do not rely on imaging but on the skills of the actual surgical work.

Bahman Guyuron, MD · Answer

Alar batten graft is usually shorter and goes on top of the existing lateral crus that keeps the nostril open while the lateral crural graft is longer and goes underneath the existing lateral crus thus is more effective than a batten graft. A batten graft is used more for the aesthetic benefits with some improvement in the valve function while lateral crural strut has both functional and aesthetic benefits. While both eliminate the convexity of the ala and improve the function of the external valve, the strut also may improve the function of the internal valve, depending on how it is place.

What is the difference between alar batten grafts and lateral crural strut grafts? Which is better for correcting a pinched tip?

Answers (7)

Answer: Alar batten grafts for pinched tip.

Answer: Alar batten grafts for pinched tip.

Answer: Alar batten versus lateral crural strut

Answer: Alar batten versus lateral crural strut

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

What is the difference between alar batten grafts and lateral crural strut grafts? Which is better for correcting a pinched tip?

Answers (7)

Answer: Alar batten grafts for pinched tip.

Answer: Alar batten grafts for pinched tip.

Answer: Alar batten versus lateral crural strut

Answer: Alar batten versus lateral crural strut

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.