Watch an intra-operative video showing how to insert alar batten grafts using a closed rhinoplasty surgical approach.
Dr. Thomas Lamperti, narrates an intra-operative video of the endonasal (closed) approach to alar batten graft placement. He also discusses where the external nasal valve is and where the graft is placed. Lastly, he shows how the marginal incision is sutured closed.
"This is Seattle facial plastic surgeon, Dr. Thomas Lamperti. Today I'm going to talk to you about how we insert alar batten grafts. Specifically, I'm going to show you the endonasal, or closed, approach to inserting grafts today. Here you can see that we've started by making what is called a marginal incision on both sides of the nose. You can see how this is placed essentially in the roof of the nostril and actually borders the lower edge of the lower lateral cartilages on both sides. Once I'm made the initial incision I'll then use a small pair of sharp scissors to make further dissection in that area. The idea is to loosen the attachments of the tissue in the area of the lower lateral cartilage. We'll then dissect a small path or tract down into the supra alar crease. Once this pocket is made we'll then be able to insert the graft into the pocket. You can see that I first tried and it wasn't quite large enough so I did some further dissection. And now we'll try to place it again. You can see that it fits a little better now. The idea is to make a very precisely sized pocket so that the graft doesn't actually have anywhere to move. I don't actually typically sew in the cartilage itself. We'll now move onto the opposite side and do the same exact type of dissection using a marginal incision as we'd made on the left side. You can see how I've made some preoperative markings with a marking pen on the outside part of the nose to denote where the area of maximal weakness is. This helps me plan the pocket dissection later on during the surgery. You can look at another youtube video where I show how I actually carve these alar batten grafts.
Now that the grafts are inserted we'll then close the marginal incisions. I typically use a chromic suture which is dissolvable. Normally it will dissolve on its own in a few weeks on its own. I also use interrupted sutures meaning it isn't a continuous line of sutures or a baseball stitch, but rather there are several interrupted individual sutures along the short incision line. I'm now placing another set of sutures to close the incision. This approach of closed alar batten graft placement is a very good way to further improve nasal breathing issues and nasal obstruction. It is often combined with septoplasty and or turbinate reduction as it was in this patient's case. The goal of the alar batten grafts is to strengthen a weakened or collapsed nasal sidewall in the area of the external nasal valve. People who find that breathe right strips help them with their airflow are often good candidates. I'd recommend consulting with a facial plastic surgeon to see what can be done to help your nasal airflow if you're having problems."