Layered Reconstruction of Full-Thickness Alar Deficiency in Tessier 1 Nasal Clefts: A 2-Case Technical Note

ObjectiveTo describe a layered reconstructive technique for full-thickness alar deficiency in unilateral Tessier 1 nasal clefts.DesignTechnical note illustrated by a 2-case series with medium-term follow-up.SettingSingle tertiary academic plastic and craniofacial surgery center.Patients, ParticipantsTwo pediatric patients aged 2 and 4 years with unilateral Tessier 1 alar clefts demonstrating full-thickness deficiency of lining, structural support, and external cover.InterventionsLayered reconstruction using a hinged cutaneous lining flap, auricular cartilage graft support, and dorsal nasal transposition flap for external cover.Main Outcome Measure(s)Clinical contour stability, nostril patency, scar quality, need for revision, and caregiver-reported satisfaction.ResultsAt 3 and 3.5 years follow-up, both patients demonstrated stable alar contour, maintained nostril patency, no collapse or notching, and no secondary revisions.ConclusionsThe described layered technique provides a feasible reconstructive option for selected Tessier 1 alar clefts with full-thickness deficiency and demonstrated encouraging medium-term stability.