BACKGROUND: Alar nostril ring correction in patients with multiple previous surgeries is one of the most challenging procedures in reconstructive rhinoplasty. Assessment of patient satisfaction and the technique's failure rate is essential in evaluating its effectiveness. OBJECTIVES: In this study, we aimed to assess the outcomes of alar nostril ring correction with auricular composite grafts (ACGs) in patients with severe postrhinoplasty deformities from multiple previous surgeries. METHODS: A retrospective review of medical records from April 2016 to October 2023 was conducted. Patient demographics, surgical techniques, and functional and aesthetic outcomes were analyzed. Patient satisfaction was measured with the Obstruction and Cosmesis scores from the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). RESULTS: A total of 45 cases (38 female and 7 male) ages 36.4 ± 7.64 years underwent alar nostril ring correction with ACGs from the antihelix, with an average of 2 previous rhinoplasties. Preoperative SCHNOS-O and SCHNOS-C scores were 88.44 (SD = 14.41) and 88.30 (SD = 12.44), respectively. The shape of the ACGs was similar to parabolic cylinders, with arc lengths between 15 and 21 mm and flat dimensions of 6 to 9 by 3 to 7 mm. No graft failures were observed, even in 10 patients with a history of nasal skin necrosis. Postoperative SCHNOS-O and SCHNOS-C scores after 1 year were 35.44 (SD = 21.07) and 35.85 (SD = 19.04), representing significant improvement (P <
0.05). CONCLUSIONS: ACGs from the antihelix effectively address external valve stenosis due to aggressive alar-sill junction tissue resection in reconstructive rhinoplasty, even in complex cases.