title: Grafting the alar rim: application as anatomical graft.
abstract: BACKGROUND
  Alar rim contour and alar rim grafts have become essential components of rhinoplasty. Ideally, grafts of the nose should be anatomical in shape. So doing might make grafts of the alar rim more robust. The authors considered doing that by applying the graft as a continuous extension of the lateral crus.
  
  
  METHODS
  Twelve patients (two men and 10 women) constituted the study group (seven primary and five secondary cases). Of those, there were five concave rims, two concave rims with rim retraction, two boxy tips, and three cephalically oriented lateral crura. Surgical technique included the following: (1) an open approach was used; (2) a marginal incision that ignored the caudal margin of the lateral crus (the incision went straight posteriorly to a point 5 to 6 mm from the rim margin) was used; (3) a triangular graft was made to cover the exposed vestibular skin; (4) it was secured end to end to the caudal border of the lateral crus; and (5) the poster end was allowed to sit in a small subcutaneous pocket.
  
  
  RESULTS
  Follow-up was 11 to 19 months. All 12 patients exhibited good rims as judged by a blinded panel. Rim retraction was not fully corrected in one patient, but no further treatment was required. One patient did require a secondary small rim graft for residual rim concavity.
  
  
  CONCLUSIONS
  The concept of grafting the alar rim is strongly supported by the authors' results. The modifications the authors applied by designing the graft to be anatomical in shape has been a technical help.
authors.affiliation: San Francisco and Stanford, Calif. From the Divisions of Plastic & Reconstructive Surgery, University of California, San Francisco; and Stanford University.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Gruber
authors.forename: Paige
authors.initials: P
authors.lastname: Fox
authors.forename: Anne
authors.initials: A
authors.lastname: Peled
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Belek
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000002:abnormalities* / Q000601:surgery; D009667:Nose Deformities, Acquired / Q000601:surgery*; D010865:Pilot Projects; D012086:Reoperation; D012225:Rhinoplasty / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult