Alar Batten Grafts: Treating external nasal valve collapse

What is an alar batten graft?

Alar batten grafts are thin, oval shaped cartilage grafts that are placed along the nasal sidewall in the area of the supra-alar crease or area of lateral wall weakness. This schematic shows roughly where alar batten grafts are typically placed:

Schematic showing were bilateral alar batten grafts are placed
 

What do alar batten grafts do?

Alar batten grafts act to add support to a weakened or pinched external nasal valve. The additional cartilage support can also provide an improvement to the contour of a pinched tip. Batten grafts are especially beneficial in treating dynamic external valve collapse. This involves the inward movement of the nasal sidewall during inspiration.

Right external nasal valve collapse before repair

This patient has significant right external valve collapse as seen in the above photograph. Her right nasal tip has severe pinching in the area above her nostril margin (supra-alar crease).

Right external valve collapse after alar batten graft placement

The photograph above shows how Dr. Lamperti was able to correct this patient's external valve collapse using an alar batten graft. The improved support is evidence by the more symmetric tip contour.

What are batten grafts made of?

Batten grafts are carved from cartilage from a patient's own septum, ear or rib. Typically, Dr. Lamperti uses septal cartilage to make batten grafts, but in situations in which a patient has had a prior septoplasty or if many grafts need to be used during surgery ear or rib cartilage can be used. 

What part of the ear does a conchal cartilage ear graft come from?

As the name implies, conchal ear cartilage grafts come from the curved conchal cartilage of the external ear. The photo below shows the two areas of the external ear where cartilage can be harvested from.


Conchal cartilage ear cartilage harvest locations
 

The larger, lower area is usually the first choice of where to harvest cartilage from. If additional cartilage is need the smaller upper area can also be used. If even more cartilage is needed the opposite ear can also be used. Dr. Lamperti typically removes the ear cartilage using an incision placed on the back of the ear, though other surgeons may prefer using an incision in frontal of the ear.

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 is how Dr. Lamperti will typically place them. If possible he tends to use a closed approach for alar batten graft placement otherwise. The incision in this case is placed along the roof inside the nostril. A pocket is dissected in the area of planned batten graft placement. Dr. Lamperti will make this pocket just big enough to fit the graft to prevent any graft movement.

This photograph shows what the carved batten grafts look like and also which area it is ultimately placed.

Carved ear cartilage graft showing where the batten grafts are placed

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 deep under the nostril skin so you can't normally see them. 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. Ultimately, the grafts should not make the nose any bigger, though it may correct any existing pinching in the area.