What are the best grafts for widening the alars and dorsum of the nose?

Question

What are the best grafts for widening the alars and dorsum of the nose after a primary rhinoplasty made them too narrow?

Jeffrey Lisiecki, MD · Answer

Great question--it depends on exactly what the deformity is and where. For a dorsum that is too narrow, this almost always means the use of spreader grafts which widen the dorsum and can help breathing. For widening the ala, there are a variety of options depending on what is structurally going on. Usually alar contour grafts are necessary to support the alar rim from collapsing in. If the alar bases are too narrow from being over-resected, this is a challenging thing to fix and sometimes it requires composite grafts from the ear cartilage and skin.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Spreader grafts and onlay grafts work well to adjust too narrow of a dorsum. We can use septum, ear, or rib cartilage for that purpose. The ala are more difficult. If a reduction was performed, those can be very hard to correct. Composite grafts work though the cosmesis is often less than ideal afterwards. If the bases were not reduced, lateral crural strut grafts with repositioning can help to create more outward bowing to the ala. I would seek consultation with a facial plastic surgeon to see what options may be best and safest for you. Hope this helps!

What are the best grafts for widening the alars and dorsum of the nose?

Answers (2)

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