The alar scroll: An important anatomical structure in lobule surgery

The alar scroll (the interval structure between the upper and lower lateral cartilages) has been an overlooked important component of nasal anatomy and rhinoplasty. The functional roll and consequences of destroying the integrity of the scroll are discussed. Among other features, the scroll provides rigidity to the area of the internal nasal valve. It also provides tip support. The need to avoid excessive disruption of the scroll is discussed. Preservation of the scroll is suggested when possible. Surgical approaches to the alar scroll and reestablishment of scroll functions are reviewed. The use of buttress grafts proves particularly helpful. These techniques are described for both the open and closed approach.