A Single Rib Integrated Scaffold for Semiopen Revision Rhinoplasty After Nasolabial Flap

Background: Patients requiring secondary rhinoplasty after nasolabial flap reconstruction often have significant scar contracture and distorted anatomy, making the standard open approach risky or impossible. We developed a single rib integrated scaffold (SRIS) that is delivered through bilateral marginal (alar rim) incisions as 4 completely separate components, which are then sutured together in situ inside the nose—avoiding the need to pass a bulky preassembled construct through a limited incision. Methods: We reviewed 20 consecutive patients treated at our single institution between January 2022 and July 2025. All underwent semiopen revision rhinoplasty performed by one surgeon using the SRIS technique. The primary outcomes were the Rhinoplasty Outcome Evaluation (ROE) score and photographic measures of alar symmetry—Alar Canting Angle (ACA) and Nostril Symmetry Index (NSI). Insertion Difficulty Score (IDS) and NOSE score were secondary. Results: All 4 components were delivered without difficulty in all 20 cases. The mean IDS was 1.4±0.5; insertion was rated effortless (IDS 1) in 17 of 20 cases. ROE scores rose from 48.5±10.2 preoperatively to 88.2±6.1 at 12 months (Δ39.7, 95% CI: 34.2–45.2; P <0.001). On photographs, ACA dropped from 4.8±1.5 degrees to 1.1±0.6 degrees (Δ3.7 degrees, 95% CI: 3.0–4.4 degrees; P <0.001) and NSI increased from 0.82±0.07 to 0.95±0.03 (Δ0.13, 95% CI: 0.09–0.17 degrees; P <0.001). NOSE scores stayed flat (4.2±2.1 vs. 4.5±2.3; P =0.452). No infections, extrusions, or scaffold displacements occurred over the 12-month follow-up. Conclusion: The SRIS technique—delivering 4 separate cartilage components through bilateral marginal incisions and suturing them together inside the nose—produces measurable short-term improvements in nasal symmetry and patient satisfaction after nasolabial flap reconstruction. These findings are hypothesis-generating; whether this approach offers advantages over conventional assembled grafts will require comparative studies. Level of Evidence: Level 4—therapeutic.