Background:Demand for correction of deformity in the alar lobule was not high compared to other anatomical subunits of the nose.With increased familiarity of open rhinoplasty technique, the importance of the nasal tip has been highlighted and consequently interest in the alar-columellar relationship has increased.Several simple and effective surgical maneuvers for balancing alar rim and columella have been published recently.However, it is true that procedures to change the shape of alar rim have room for development.Of course, well-known composite grafts in the form of conchal cartilage with skin or septal cartilage with mucosa are good ways to correct a retracted ala, it has demerits in that sometimes a nodule is formed in the external nasal cavity, or the graft becomes dislocated or shrinks, and predictability regarding post-operative results is low.Method:The author has tried to overcome the demerits of composite grafts by:(1) Onlay-grafting triangular septal cartilage (alar extension graft) on the anterior surface of the lower lateral cartilage with the medial base fixed (2) placing the lateral end of alar extension graft into the vestibular skin pocket as a finger-in-glove pattern, (3) using the vestibular skin in the form of an U-shaped flap, and (4) using the shield graft to mask the possible visible step-off which could be noted due to thickness of the alar extension graft.Result:The author applied the alar extension graft to 16 patients in order to correct a retracted ala for the last twenty seven months.In all of the cases, the distance form the long axis of nostril to the alar rim was corrected to be within 2mm, and also the shape of the alar rim changed to a round form.In addition, problems of nodules in the nasal cavity, and graft dislocation and shrinkage were not found, and the vestibular flap also survived without vascular compromise.Nostril asymmetry (6%) in one case, temporary papable step-off(18%) in three cases, and temporary paresthesia of the tip (25%) in four cases were observed.Conclusion:In the alar extension graft, nodules in the nasal cavity, and graft dislocation or shrinkage, which have been pointed out as demerits of composite grafts, were not found, and another donor sites were not necessary.The long term results of such operations are predictable.Furthermore, when the intensity of lower lateral cartilage is weak, it may have an ancillary effect that the shape of the lobule is improved by increasing the structural intensity of the lower lateral cartilage.Accordingly, it is considered that it may be a preferential method to correct retracted ala which is caused by congenital hypoplasia or misshape of lower lateral cartilage.