Aesth. Plast. Surg. 27:418–422, 2003
DOI: 10.1007/s00266-003-3091-1

Surgical Correction of Retracted Nostril Rim with AuricularComposite Grafts and Anchoring Suspension
Toshitsugu Hirohi, M.D., and Kotaro Yoshimura, M.D.
Tokyo, Japan

Abstract. Among concerned nasal appearances, a deformity with supero-lateral displacement of the nostril rim,
called retracted nostril rim or elevated nostril rim is commonly seen and is considered one of the most diﬃcult typesof cases to treat aesthetically. A new surgical method fortreating retracted nostril rim was performed in 10 patients,using the combination of auricular composite graft, internalﬁxation with a retainer, and external continuing suspension
with anchoring sutures. The procedure was successful inmaintaining the grafted cartilage in the ideal position and in
avoiding recurrence of retraction or elevation of the constructed alar rim. The presented method merits consideration as a standard operative approach for correction ofretracted nostril rim.
Key words: Elevated nostril rim—Retracted ala—Cartilage
graft—External suspension—Retainer

The shape of the nostril rim is a sensitive topic,especially among women. Retracted or elevated(supero-lateral displacement) nostril rim occurs congenitally, or iatrogenically due to scar contracture
after various kinds of rhinoplasty. Gunter et al. [1]previously suggested a deﬁnition of retracted ala as adeformity characterized by an alar rim to nostril longaxis distance of more than 2 mm. Retracted alar rims
make the nostrils appear too big, and nasal hair beseen from oblique and lateral views. As for the unilateral cases, the most common complaint is amarked diﬀerence in the size and shape of the nostril

Correspondence to Toshitsugu Hirohi, M.D., Ritx
Cosmetic Surgery Clinic Tokyo, 6F-3-1-7, Kamiosaki,
Shinagawa-Ku, Tokyo 141-0021, Japan; email: hirohi@ritz-cs.Comrim. Morphologically, retracted nostril rims can beclassiﬁed into two types: Type I includes those cases
where the nostril rim is completely displaced superolaterally, and the nasal cavity can be seen from thefrontal view. Type II includes those cases where partof the nostril rim is supero-laterally displaced andappears to be notched. Type I occurs congenitallyand is usually bilateral, whereas type II occurs bothcongenitally and iatrogenically, and iatrogenic cases
involve usually only one side.
Although retracted nostril rims are seen frequently,
and there have been several surgical techniques andmodiﬁcations for it, it is still considered one of themost diﬃcult nasal deformities to treat. Meyer andKesselring [2] introduced a method for lowering thealar rim with a graft of alar cartilage strip, and Ellenbogen [3] modiﬁed the method as a combined
technique with a local skin ﬂap and a cartilage graft(septal, lower lateral, or auricular). Ellenbogen’s
method, however, left a raw surface on the internal
mucosa, which could lead to postoperative complications such as distortion, retraction, and protrusionof the grafted cartilage. Guyuron [4] used an internal
V-to-Y advancement with or without a cartilage graft
for the severe alar retraction, and Rohrich et al. [5]utilized alar contour grafting with septal cartilage.
Constantian [6] used Sheen and Sheen’s method [7]with minor modiﬁcations and showed relatively successful results by using skin and cartilage composite
grafts harvested mainly from the auricle for secondary or tertiary rhinoplasty. Based on our experiences,insuﬃcient improvements or postoperative retractions can be seen, especially in severe cases of retracted alar rim deformity or in the cases withscarring.
The authors modiﬁed the previously mentioned
methods to avoid postoperative retraction of thenostril rim by combining auricular composite grafts
and postoperative anchoring suspension.