See how alar rim grafts can be used to treat tip pinching and alar retraction.

Thomas Lamperti, MD, narrates the his latest SurgeonCam video which shows  how to carve and place an alar rim graft during open rhinoplasty surgery.

Video Transcript:

"This is Seattle facial plastic surgeon, Dr. Thomas Lamperti. Today I'm going to show you how to place alar rim grafts to support the nostril margins.

I'll first show you a schematic drawing showing where alar rim grafts are placed. Before carving the rim grafts I first measure the approximate distance that I want the alar rim graft to span. And then use this to gauge how long to carve the rim graft using the harvested septal cartilage.

Here I'm carving the graft itself. I want the graft to be relatively thin but long. I also taper the edge where it approaches the dome area to prevent it from being palpable. Once I'm happy with the graft carving I'll next move to dissecting the pocket in the left alar rim region. The key is to dissect a relatively tight pocket so that the graft doesn't have a chance to migrate. I dissect just along the nostril rim paying particular attention to avoid buttonholing with the scissors through the nasal tip skin.

Now that I've completed dissecting the first rim graft pocket I will take the cartilage graft and insert it into the newly created pocket. We want the medial end of the rim graft to end just before the domal area. Once I'm happy with the positioning of the graft I'll then morselize the medial end with forceps. This helps to soften the end of the graft and further prevent palpability of the graft as the nasal swelling comes down.

Next I'll place a small dissolvable suture around the end of the graft to further hold it in place as the nose heels. I often use a 6-0 fast gut or monocryl suture for this step.
     
Once I finish the suturing on the left I'll then repeat the process on the right side.  Alar rim grafts are very versatile. They can be used to treat tip pinching in this area. This could be seeing often on base view of the nose where this part of the nostril wall buckles and bows inward. The end result of this is often seen in people who's nasal tip seems isolated compared to the rest of their nose. They also may describe having a ball on the end of their nose.

Alar rim grafts are also a great way to treat mild alar retraction. They allow rhinoplasty surgeons to mobilize the alar rim downward to reduce excessive columellar show. There is a  limitation to how much retraction can be treated this way. More severe or significant retraction is better treated with lower lateral cartilage repositioning."