New Concept for Articulated Alar Rim Graft Positioning.

The articulated alar rim graft (AARG) proposed by Davis is a simple and effective method for avoiding and correcting most alar rim deformities in rhinoplasty. In addition to its benefit for the nasal ala, the position suggested herein allows for a precise definition of the facet polygon and infratip lobule. A retrospective series of 317 patients surgically treated with the modified AARG positioning were evaluated. The height of the septal extension graft was always a few millimeters above the new dome, without demanding excessive lateral crural tensioning (LCT), and the AARG itself was fixed more on the facet polygon and infratip than in the standard procedure. The results were favorable after 1 year of follow-up. The proposed AARG modification yielded good nasal tip projection and definition without excess LCT, enhanced the facet polygon and supra-alar sulcus, and stretched the skin downward. Functional gain was reported by most patients. Few minor and common complications were reported. The use of this modified AARG position can avoid and correct most alar deformities, with the added benefit of providing better control over tip definition without the need for excessive LCT or overprojection of the nose.