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The alar batten graft is the workhorse for functional rhinoplasty and used when there is collapse at the sidewall.1 This graft is used to support the lateral nasal wall and/or lower lateral cartilage and prevent collapse during inspiration. It is not intended to create a major change in resting anatomy, nor does it address middle vault narrowing. The anatomic epicenter of collapse varies but is most often at the intervalve area—the space between the internal and external valves, underlying the supra-alar crease. Recurvature of the lateral crura frequently coexists and can be corrected this way. Occasionally, the graft needs to be placed more caudally, within the alar lobule itself, to lend some support to the external valve. Thus, the preoperative assessment is critical for determining the exact location of dynamic collapse. Both endonasal and external approaches are possible, although the latter is used more frequently because of multiple grafts and sutures.
Chua DY, Park SS. Alar Batten Grafts. JAMA Facial Plast Surg. 2014;16(5):377–378. doi:10.1001/jamafacial.2014.490
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