Objectives: The authors suggest a modification in the positioning of the graft, considering aesthetic concepts in the nasal tip region, mainly in the facet polygon and infratip lobule. The objective of this article is to demonstrate the authors’ experience in defining the nasal tip in the treatment and prevention of retraction and deformity of the alar margin with a new AARG position and to analyze the results obtained. The authors suggest this new AARG position to gain more control over the nasal tip projection and definition.

Introduction: The articulated alar rim graft (AARG) proposed by Davis1 is a simple and effective method for avoiding and correcting most alar rim deformities in rhinoplasty. In addition to its benefit for the nasal ala, the position suggested herein allows precise definition of the facet polygon and infratip lobule.

Materials / method: A retrospective series of 317 patients surgically treated with the modified AARG positioning were evaluated. The height of the septal extension graft was always a few millimeters above the new dome, without demanding excessive lateral crural tensioning (LCT), and the AARG itself was fixed more on the facet polygon and infratip than in the standard procedure.

Results: The results were favorable after 1 year of follow-up. The proposed AARG modification yielded good nasal tip projection and definition without excess LCT, enhanced the facet polygon and supra-alar sulcus, and stretched the skin downward. Functional gain was reported by most patients. Few minor and common complications were reported.

Conclusion: The use of this modified AARG position can avoid and correct most alar deformities, with the added benefit of providing better control over tip definition without the need for excessive LCT or overprojection of the nose.

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Objectives: Alar cartilages have been under the “eyes” of different rhinoplasty surgeons like Jack Gunter, John Tebbets..developping the famous Tripod Concept . concept likens the skeletal support of the nasal tip to a tripod, with one central leg formed by the conjoined medial crura of the lower lateral cartilages, and two lateral legs formed by the lateral crura sometimes in thin patients is not worthy...

Introduction: Jack Sheen, MD discussed this concept due to the lack of support, of the nasal valve. For this reason he published 1987 the concept of Alar Cartilage Malposition where the axis is lateral instead than medial or nasal.

Materials / method: Nowadays, the concept of alar support has gained popularity, thanks god but still we found collapse alar rim in consequences decreased airflow.

Results: We present primary cases and secondary cases using a 3D graphics.

Conclusion: Like "lower lid malposition" "alar rim malposition "need to be examined before. The consequences are not immediate but they appear in the long run.

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