See how an alar batten graft can be used to treat a patient's pinched tip and external valve collapse and improve  nasal congestion.

Last time I talked about how we can treat external valve collapse with lower lateral cartilage repositioning. A bit more common and straightforward way to address narrowed or collapsed external nasal valves is to use alar batten grafts.

What is an alar batten graft?

Like I talked about in a prior post, alar batten grafts are oval shaped cartilage grafts that are placed along the nasal sidewall in the area of the supra- alar crease or area of maximal lateral nasal wall collapse.



The schematic above illustrates in what general area they are placed.

How are alar batten grafts inserted?

Alar batten grafts can be inserted using either a closed or open rhinoplasty approach. If other aspects of the surgery require an open approach that's how I'll place them. If possible I tend to use a closed approach for alar batten graft placement otherwise. The incision in this case is placed along the roof inside the nostril. This allows us to dissect a pocket in the proper part of the nasal sidewall.

Unilateral Alar Batten Graft Case Study

Let's check out how an alar batten graft can successfully treat unilateral external valve collapse.



This patient's right supra-alar crease is quite prominent leading to internal nasal narrowing.



This oblique view further illustrates the narrowing in this area.

Combined septoplasty and Alar batten graft placement

This patient also had a deviated septum so during surgery I first straightened her septum and harvested septal cartilage. Next a small incision was placed along the roof of her inner nostril opening. I then carved the harvested septal cartilage into an alar batten graft that I then placed into a pocket in the area of maximal nasal collapse. They key here is to make sure the cartilage graft is long enough to contact the bone of the piriform aperture (the bony part of the upper jaw bone deep to the nostrils). This creates the necessary support needed to maintain an open airway.



This frontal after photo shows how much more symmetric and well supported the right supra-alar area is. Importantly, the patient's breathing also improved. This patient is a great example of how improving the function of the nose also leads to a better looking nose.

Can you see alar batten grafts?

People often wonder if they'll be able to see the alar batten grafts once they're placed. Some also express concern that the grafts will make their nose look wider. Once the nose heals the grafts shouldn't widen the nose. The normal postoperative swelling will obviously temporarily make the area more full but this subsides with time. The grafts themselves are placed deeply under the nostril skin so you can't normally see them. I do tell patients that it is normal to be able to feel them under the skin, much like how you can feel the normal cartilage of your nasal tip.

Another way to address weak external nasal valve is to place lower lateral cartilage strut grafts. Learn more about LLC strut grafting here. Check out some of my other rhinoplasty blog posts here.

Related Seattle Rhinoplasty Posts:

• Lower lateral cartilage repositioning to fix tip pinching and external valve collapse
• How functional rhinoplasty can create a permanent breathe right strip effect
• Pinched nasal tip revision rhinoplasty surgery
• Nose job I-beams:lower lateral cartilage strut grafting
• Lend me an ear: ear cartilage alar batten grafts