Background: A deviated nose can be attributable to multiple anatomical factors, including asymmetric maxilla. A subalar graft helps to correct maxillary hypoplasia and may be a useful tool for correcting a deviated nose. The authors' objective is to show the effects of the subalar graft in improving nostril symmetry and to propose an algorithm for using this graft in open and endonasal rhinoplasty. Methods: A retrospective case series was performed on patients who had undergone rhinoplasty performed by the senior author (R.W.) from September of 2008 to July of 2015. Patients with at least 3 months of follow-up and adequate photographs were included. The mean follow-up period was 11.0 months (range, 3 to 72 months). A total of 68 patients were included. Preoperative and postoperative photographs were analyzed to measure changes in nasal axis deviation, alar facial angle on base view, alar facial angle on frontal view, and nostril show bilaterally. Results: Of the 68 patients, statistically significant improvement of nasal axis deviation of 4.32 degrees toward the midline was observed. Alar facial angle on base view was improved 1.01 degrees toward the horizontal. Nostril symmetry also improved based on the ratio between the shorter side and the longer side. The mean change in nostril show ratio was 0.19 toward a 1:1 ratio. Conclusions: Previous studies have shown that the subalar grafting technique is an important adjunctive technique in rhinoplasty for patients with midfacial asymmetries. This case series demonstrates that this technique can provide sustained results in the correction of the nasal foundation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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