The subalar graft and its role in nasal tip medialization and improved nostril symmetry.
OBJECTIVE
Relationships between nasal axis deviation and lower midfacial asymmetry or hypoplasia have been established in prior studies. We describe our experience with the subalar grafting technique in addressing nasal tip deviation associated with facial asymmetry. Indications in using this graft in isolation or in conjunction with other tip modification techniques are also investigated.


METHODS
Retrospective case series.


METHODS
Academic medical center.


METHODS
Thirty-seven consecutive patients from a single surgeon (R.W.W.) treated using subalar grafting are evaluated for correction. Various measurements from preoperative and postoperative photographs are analyzed to determine the effectiveness of this intervention.


RESULTS
Statistically significant correlations between improvement in nasal axis and alar-facial angle on base view (AFAB) (P < .001) and between alar-facial angle on frontal view (AFAF) (P = .017) were observed. In addition, a significant correlation between AFAB improvement and AFAF normalization was observed (P < .001). The improved nostril symmetry was significantly correlated with base view correction and was not the result of general improvements in nasal deviation.


CONCLUSIONS
While measuring the independent effects of subalar grafting is limited due to contaminant procedures, it can be recognized as a foundation rhinoplasty technique that, in conjunction with septoplasty, provides medialization of the tip in patients with facial asymmetry. Furthermore, aesthetic correction of nostril horizontal dystopia and/or nostril "show" is achieved with the proper application of this technique. This correction represents a unique intervention in rhinoplasty and should be considered a second indication for its use.
State University of New York Downstate Medical Center, Brooklyn, New York, USA.
Behrad B
BB
Aynehchi
Miguel E
ME
Mascaro
Richard M
RM
Rosenfeld
Richard W
RW
Westreich
D000046:Academic Medical Centers; D000328:Adult; D002508:Cephalometry; D005146:Facial Asymmetry / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D055171:Nasal Cartilages; D009300:Nasal Septum / Q000473:pathology / Q000601:surgery*; D009519:New York City; D009666:Nose / Q000002:abnormalities / Q000601:surgery*; D009667:Nose Deformities, Acquired / Q000601:surgery*; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D019737:Transplants; D016896:Treatment Outcome
nasal reconstruction; rhinoplasty