Scalp grafting as a reconstructive technique for severe alar retraction
Reviewed by Shivanchan Rajmohan

Severe alar retraction is an acknowledged challenging aspect of revision rhinoplasty. Traditional grafting methods such as composite grafts, nasolabial flaps and cutaneous alar rotation flaps often carry limitations, including visible scarring, colour mismatch and reduced graft survivability. This retrospective cohort study in China evaluated 18 female patients (mean age 31 years) who underwent revision rhinoplasty for severe alar retraction over a one-year period with mean follow-up period of 10 months. Under general anaesthesia, harvested full thickness temporal scalp grafts were implanted into alar rim defects following repositioning, and external silicone plates were sutured bilaterally for graft stability. Postoperative outcomes were assessed using both the visual analogue scale (VAS) and the rhinoplasty outcomes evaluation (ROE) questionnaire. Patients demonstrated statistically significant postoperative improvements in objective nasal measurements and patient-reported outcomes. Mean ROE scores significantly increased from 59.03±12.60 to 87.15 ± 8.58 postoperatively and VAS scores improved from 3.25±0.83 to 9.17±0.55 postoperatively. Notably, no cases of graft necrosis, structural collapse or major complications were observed, and all patients reported high satisfaction with aesthetic results. The study noted scalp grafts superior graft survivability, concealed donor site scars and colour compatibility with the nasal vestibule. Unlike composite or flap techniques, scalp grafts avoid conspicuous scarring and nasal obstruction. The results must be considered within the context of a limited cohort derived from a single ethnic population. Overall, this study displays scalp grafting to be a safe, innovative and aesthetically advantageous option for correcting severe alar retraction. One may postulate whether the classification system and scalp grafting technique described in this study can be reliably translated to non-Asian populations with differing nasal anatomy and aesthetic norms.

Application of scalp graft in the correction of severe alar retraction.
Zeng W, Wang X, Zhao H, et al.
J PLAST RECONSTR AESTHET SURG
2025:104:209–14.