The Lateral Crural-Rim Bridging Graft: An Integrated Solution for Dual-Level Alar Retraction

Abstract

Alar rim retraction (ARR) is a challenging iatrogenic complication in rhinoplasty, causing aesthetic distortion and functional compromise. Complex secondary cases often involve compounded deficiencies in both the lower lateral cartilage (alar rim) and the caudal upper lateral cartilage (ULC). Current isolated grafting techniques (eg, Lateral Crural Extension Graft or LCEG) often fail to provide complete, harmonious correction in these dual-level defects, highlighting the need for a unified reconstructive strategy like the novel Lateral Crural-Rim Bridging Graft (LCRBG). A 32-year-old woman presented with progressive, unilateral ARR following primary rhinoplasty, causing asymmetric nostril show and functional distortion. She underwent secondary rhinoplasty using the LCRBG technique. A 2.5 cm × 8 mm septal cartilage graft was harvested and precisely secured to span from the residual lateral crus to the deficient caudal ULC. The procedure was well-tolerated and achieved the desired correction of the alar rim position. The LCRBG offers a novel, unified solution for complex secondary rhinoplasty, simultaneously correcting ARR and supporting the deficient caudal ULC. By bridging these 2 levels, it restores anatomical continuity, improves contour, and addresses limitations of traditional single-level grafting. Further prospective studies are necessary to fully validate its efficacy.