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Background:. Nasal alar deformity after cosmetic surgery, including nostril sill notching, alar flattening, and a shallow and indistinct alar-facial crease, commonly results from overresection. We developed revision methods for postoperative alar deformity, and applied them from 2016 to 2022 to the revision of 16 cases, consisting of 1 male and 15 female patients, with a median age of 28.5 years. Methods:. Auricular cartilage grafting was used as the main technique to improve alar flattening and notching without risking a poor color match as is seen in composite grafting. Notching was also improved by adding an alar lobule island flap if there was usable excess tissue on the lateral side of the ala. Two cinching sutures were used to define the alar-facial crease. Results:. Median follow-up was 9.25 months (range, 0.5–96 mo). All lobule flaps survived. Cartilage graft infection occurred in 1 case, requiring removal of the graft. Conclusions:. Alar flattening and other deformities often result from too-aggressive nasal cosmetic surgery. These can be corrected using lobule flaps and auricular cartilage grafts, which, unlike composite grafts, do not undergo degeneration with the associated risk of ischemia or discoloration.

Objectives: Many Asian patients with nasal aesthetic surgery desire a sharper, more defined nasal tip. In many cases, their nasal cartilage is not abundant enough, necessitating cartilage transplantation from an extranasal location. We investigated which patients would qualify for a method of reshaping the nasal tip without needing donor cartilage by reshaping the lower cartilage using the transdomal suture technique and local cartilage grafting. Methods: We performed a single-center retrospective cohort study of patients undergoing nasal tip surgery. We divided patients into two groups. Group 1 comprised 13 patients with nasal tips with thin skin and soft tissue and relatively abundant cartilage. Group 2 included 31 patients with nasal tips with thicker, firmer skin and soft tissue and a smaller amount of cartilage. No patients had prior nasal surgery, and all patients were followed up for at least 3 months. Patients in both groups underwent the transdomal suture technique and local cartilage grafting. Five patients in Group 2 underwent alar reduction. Preoperative and postoperative lateral view photographs were superimposed and analyzed to measure changes in tip projection. Results: Patients in Group 1 showed a mean increase in tip projection of 3.9%. Patients in Group 2 demonstrated a mean decrease in tip projection of −1.5% without alar reduction and −5.6% with alar reduction. Conclusions: If the nasal tip is predominantly cartilaginous, patients may undergo surgery that does not involve donor cartilage from another site with good results. However, most patients, who have a relatively small amount of nasal tip cartilage, are not good candidates for this procedure.