Aesthetic Outcomes of Alar Base Resection in Asian Patients Undergoing Rhinoplasty

Abstract

IMPORTANCE Combined sill and alar excision is a useful procedure for correcting a wide nasal base and flared alar lobules. However, the aesthetic outcomes of this technique remain poorly reported.OBJECTIVE To evaluate the aesthetic outcomes of combined sill and alar excision in Asian patients undergoing rhinoplasty. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study of 73 consecutive patients who underwent combined sill and alar excision from March 1, 2004, to January 31, 2013, was conducted at a tertiary referral hospital in Korea.EXPOSURE Combined sill and alar excision. MAIN OUTCOMES AND MEASURESChanges in the ratio of the interalar distance to intercanthal distance and frequencies of alar flaring, nostril symmetry, and nostril shape, as measured by reviewing photographs taken before and after the surgery. RESULTS Among the 73 patients (50 men and 23 women; mean [SD] age, 36.5 [12.3] years) the mean (SD) ratio of interalar distance to intercanthal distance changed significantly from 1.07 (0.11) to 1.04 (0.08) (P < .001). Of the 60 patients with alar flaring, 45 (75%) no longer had flaring after the procedure. The frequency of nostril symmetry increased from 38 patients (52%) to 46 (63%) (P < .001). The frequency of horizontally shaped nostrils decreased from 21 patients (29%) to 2 (3%), while the frequency of the preferred pear-shaped nostrils increased from 20 patients (27%) to 35 (48%) (odds ratio, 1.16; 95% CI, 0.63-2.14; P = .02). There were 4 cases of complications, namely, alar deformity (1 patient [1%]), unsatisfactory correction of asymmetrical nostrils (1 [1%]), and unsatisfactory correction of alar flaring (2 [3%]). CONCLUSIONS AND RELEVANCECombined sill and alar excision was a useful technique with a low complication rate for correcting wide alar base, alar flaring, nostril asymmetry, and nostril shape.LEVEL OF EVIDENCE 4.

Correction of Post-Cleft Lip Nostril Floor Stenosis: Para-Alar Flap Combined With Lip Revision

“…One of the criticisms of the current technique is the perialar scar. Although in a contrary opinion; in adult rhinoplasty; studies using the alar base excision and reduction are showing acceptable hidden scar when it is placed in the alo-facial groove (Foda, 2007; Kim et al, 2016). We recommend a slight over correction of the stenotic nostril, as minor stenosis relapse occurs during the healing process as shown in the differential width changes in late versus immediate postoperative measurements.…”

Modification of the Basal View after Internal Alar Reduction

“…Many surgeons hesitate to perform alar base excision, in spite of its gratifying results, for fear of obvious scarring and unnatural outcome. Complications of alar soft tissue excision can include notching, apparent scars, asymmetry and nostril deformity [13]. The pull of the facial musculature may have the effect of widening the scar when the incision is placed in the crease [16].…”

“…This is opposed to our described technique, which addresses each sill separately, and is therefore useful even in cases of asymmetry. Consequently, the long-term effect of the cinching suture technique is considered doubtful [13].…”

Categorization and Analysis of Nasal Base Shapes Using a Parametric Model

“…16 Physician assessments of postoperative nasal bases have also been described with subjective visual assessment of alar flaring, nostril shape and symmetry, and evaluation of the nasal base width to intercanthal width ratio. 3 All of these patient-reported and physician-reported outcome measurements are largely subjective; furthermore, there is frequently discordance between patient selfassessment and professional assessment of postrhinoplasty results. 5 Categorization systems classifying nasal base shape have been previously described and are largely qualitative, relying on expertise of the observer participating in visual inspection of the nasal base.…”

“…Rhinoplasty outcome evaluations by both expert surgeons and using various patientreported outcome measure tools have been reported; however, these assessments are subjective and may be not be sufficiently informative or reproducible. [1][2][3][4] Furthermore, patient and physician assessments may differ. 5 The nasal base view is important for overall appearance and balance of the nose and is one of several nasal features that must be optimized during rhinoplasty.…”