title: Alar retraction: etiology, treatment, and prevention.
abstract: OBJECTIVE
  The effect of different rhinoplasty maneuvers on alar retraction remains to be elucidated.
  
  
  OBJECTIVE
  To determine the etiology and treatment of alar retraction based on a series of specific rhinoplasty maneuvers.
  
  
  METHODS
  Retrospective review of a single surgeon's rhinoplasty digital photo database, examining preoperative alar retraction from January 1, 2002, to December 31, 2005, in 520 patients. Patients with more than 1 mm of alar retraction on preoperative photographs were identified. Postoperative photographs were examined to determine the effect of specific rhinoplasty maneuvers on the position of the alar margin; these maneuvers included cephalic trim, cephalic positioning of the lower lateral cartilage, composite grafts, alar rim grafts, alar batten grafts, and overlay of the lower lateral cartilage.
  
  
  METHODS
  Tertiary care academic health center.
  
  
  METHODS
  Forty-five patients with alar retraction met inclusion criteria, resulting in 63 nasal halves with alar retraction.
  
  
  METHODS
  Intraoperative findings, postoperative results.
  
  
  RESULTS
  Forty-seven percent of the patients (n = 21) had prior surgery; 47% also had cephalically positioned lower lateral cartilages. Among patients with less than 4 mm of cartilage width at the outset, 46% of those who received supportive grafts achieved target correction vs only 7% for patients who did not undergo supportive cartilage grafting. In patients who underwent more than 4 mm of cephalic trim, those who received supportive grafts achieved 46% of target correction vs 11% among those who did not. Ninety-five percent of composite grafts, 69% of alar strut grafts, 47% of alar rim grafts, 43% of vertical lobule division, and 12% of alar batten grafts achieved their target correction values.
  
  
  CONCLUSIONS
  Alar retraction is a highly complex problem. It can be seen de novo and is associated with cephalically positioned lower lateral cartilages. Structurally supportive grafting-including composite grafts, alar strut grafts, alar rim grafts, vertical lobule division, and alar batten grafts-can improve alar retraction.
  
  
  METHODS
  4.
authors.affiliation: Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, New York University, New York, New York 10016, USA. ashlin_alexander@yahoo.com
authors.forename: Ashlin J
authors.initials: AJ
authors.lastname: Alexander
authors.forename: Anil R
authors.initials: AR
authors.lastname: Shah
authors.forename: Minas S
authors.initials: MS
authors.lastname: Constantinides
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D016208:Databases, Factual; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000503:physiopathology* / Q000601:surgery*; D009300:Nasal Septum / Q000503:physiopathology / Q000601:surgery*; D009667:Nose Deformities, Acquired / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome