Nasal Base Narrowing

Abstract

To evaluate the role of the combined alar base excision technique in narrowing the nasal base and correcting excessive alar flare.Methods: The study included 60 cases presenting with a wide nasal base and excessive alar flaring. The surgical procedure combined an external alar wedge resection with an internal vestibular floor excision. All cases were followed up for a mean of 32 (range, 12-144) months. Nasal tip modification and correction of any preexisting caudal septal deformities were always completed before the nasal base narrowing. Results:The mean width of the external alar wedge excised was 7.2 (range, 4-11) mm, whereas the mean width of the sill excision was 3.1 (range, 2-7) mm. Completing the internal excision first resulted in a more conservative external resection, thus avoiding any blunting of the alar-facial crease. No cases of postoperative bleeding, infection, or keloid formation were encountered, and the external alar wedge excision healed with an inconspicuous scar that was well hidden in the depth of the alar-facial crease. Finally, the risk of notching of the alar rim, which can occur at the junction of the external and internal excisions, was significantly reduced by adopting a 2-layered closure of the vestibular floor (P=.01). Conclusions:The combined alar base excision resulted in effective narrowing of the nasal base with elimination of excessive alar flare. Commonly feared complications, such as blunting of the alar-facial crease or notching of the alar rim, were avoided by using simple modifications in the technique of excision and closure.

Aesthetic Outcomes of Alar Base Resection in Asian Patients Undergoing Rhinoplasty

“…Although there are numerous reports that describe specific alar base surgical techniques, to our knowledge, there are relatively few reports on the surgical outcomes of these techniques. Foda 11 suggested that the combined alar base excision technique is effective for narrowing the alar base and reducing alar flare. Since the external incision is located in the alar-facial crease and continues in the groove between the sill and upper lip, the scar that is left is inconspicuous as it is well hidden within the natural alar crease.…”

Preservation of nostril morphology in nasal base reduction

“…Several reports have described procedures that avoid notching of the nostril sill [6][7][8]. One common method is the addition of deep layer sutures when closing the wound.…”

“…Although this method results in narrowing of the nostrils and a true decrease in the width of the nasal base, a common complication is notching of the nasal sill rim at the site of the sill excision ( Fig. 1) [5][6][7][8].…”

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

“…Various modifications have been attempted since then to achieve acceptable results. Foda [ 5 ] described the 'boomerang excision technique', which combines external alar wedge resection with internal vestibular floor excision. The internal excision was inclined 30°–45° laterally to form the inner limb of the boomerang.…”