The Navicular Graft Or Reconstructing Deep Alar Defects

The reconstruction of deep nasal alar defects can be challenging. The often thick, sebaceous skin of the nose provides structural support helping maintain the alar shape and nasal patency; loss of this support may result in alar deformity and nasal vestibule collapse. Traditional full-thickness skin grafts of deep alar defects may result in depressed scars. We present a variation of the full-thickness skin graft to repair deeper alar defects, sculpting the graft into a boat-shaped or "navicular" form. This allows for sufficient volume restoration and good cosmesis while avoiding more extensive surgical repairs of the nasal alar. The navicular graft offers several advantages: the avoidance of more extensive procedures involving cartilage grafts and/or flaps, appropriate color/texture match, and volume restoration without pitting, notching, or retraction of nasal structures. In addition, no struts or bolsters are needed.