Treatment of Alar Deformity After Cosmetic Surgery

Background: Nasal alar deformity after cosmetic surgery, including nostril sill notching, alar flattening, and a shallow and indistinct alar-facial crease, commonly results from overresection. We developed revision methods for postoperative alar deformity, and applied them from 2016 to 2022 to the revision of 16 cases, consisting of 1 male and 15 female patients, with a median age of 28.5 years. Methods: Auricular cartilage grafting was used as the main technique to improve alar flattening and notching without risking a poor color match as is seen in composite grafting. Notching was also improved by adding an alar lobule island flap if there was usable excess tissue on the lateral side of the ala. Two cinching sutures were used to define the alar-facial crease. Results: Median follow-up was 9.25 months (range, 0.5–96 mo). All lobule flaps survived. Cartilage graft infection occurred in 1 case, requiring removal of the graft. Conclusions: Alar flattening and other deformities often result from too-aggressive nasal cosmetic surgery. These can be corrected using lobule flaps and auricular cartilage grafts, which, unlike composite grafts, do not undergo degeneration with the associated risk of ischemia or discoloration.