Nostrilplasty: Raising, lowering, widening, and symmetry correction of the alar rim

Abstract

Background: Although the alar rim has frequently been neglected in correction of nasal deformities, techniques for its improvement have been proposed and used successfully. Objective: Two techniques for correction of the deformed alar rim are described. Methods: To lower the alar rim, the internal skin of the vestibule is dissected away from the areolar tissue and brought down as a flap. A segment of cartilage is taken from the septum or upper portion of the lower lateral cartilage. The cartilage graft is placed in the rim and the vestibular mucosa is folded over the graft and sutured to hold the cartilage in place. Raising of the alar rim is accomplished through direct excision to raise the rim and to make the nostril longer or wider. This technique is applicable to correction of a dropped rim, pinched nostrils, hidden columella, sigmoid ala, small nostrils, and foreshortened nose. Results: These techniques have been used to treat primary, secondary, and traumatic nasal deformities in more than 200 patients during the past 20 years with few complications. Conclusions: Although the techniques described require a learning curve, once mastered they can be combined with other techniques used routinely in rhinoplasty to successfully treat a variety of nasal deformities. (Aesthetic Surg J 2002;22:227-237.)