A Refined Technique for Management of Nasal Flaring: The Quest for the Holy Grail of Alar Base Modification

Abstract

“A smile is happiness you'll find right under your nose”– Tom Wilson. This quote holds true just for patients, not for surgeons. The correction of the nose always poses a challenge to the cosmetic surgeon. Deformities of the external and internal nose may be congenital or acquired and may be secondary to soft tissue and/or osseo-cartilaginous abnormalities, leading to aesthetic and/or functional consequences. Alar flare poses a common problem, sometimes alone and sometimes in conjunction with other external deformities. Alar base reduction is generally considered when the interalar distance exceeds the intercanthal distance. It has been well documented that this simple additional procedure brings about a substantial enhancement in the nose. Various techniques have been described and used in the past, each having their benefits and drawbacks, with the modified Weir wedge excision, Aufricht nasal sill excision, and Bernstein V-Y advancement being the common ones. We hereby describe a technique that is simple yet effective in achieving the desired results and at the same time aims at preventing relapse to obtain satisfactory long term results.

The Impact of Alar Flare Reduction Goes Beyond Just the Ala

“…Many previous studies have described the direct alterations of the AFR on the nasal anatomy. 2,[7][8][9][10][11]12 However, AFR is commonly performed without consideration of the changes to other features in the nose or the cheek. In this study, our group used three-dimensional technology to describe and quantify how an isolated AFR procedure performed on donor cadavers would alter nasal and perinasal anatomy and proportions.…”

“…Today, there are numerous approaches to correct alar flaring, with many variations. 1,2,6,7 Rohrich et al 1 recently described an anatomical approach to alar flare reduction. This study categorized three types of alar flaring based on alar base and nostril relationships.…”

Modified Alar Base Reduction: A Novel Technique

“…Various techniques have been described to minimize scars, with varying degrees of success. [13][14][15][16][17] Internally hiding the incision in the vestibule, as described by Joseph, can result in alar rim notching. 14,15,18 Modifying the inclination, location, and tissue removal amount of the incision line can help reduce scar visibility.…”

“…Various techniques have been described to minimize scars, with varying degrees of success 13–17 . Internally hiding the incision in the vestibule, as described by Joseph, can result in alar rim notching 14,15,18 .…”

Surgical Tips for the Management of the Wide Nasal Base

“…The authors advocate the stepwise approach (alar base excision first followed by final evaluation and excision for alar flare) as opposed to simultaneous excision advocated by others. 5,11 The authors believe that this stepwise approach leads to less overall resection while maintaining natural contours, creating minimal scarring, and achieving high patient satisfaction.…”