“The magic finger technique” a simplified approach for more symmetric results in alar base resection

Abstract

Alar base surgery is one of the most important and challenging steps of aesthetic rhinoplasty. While an ideally shaped alar base is the goal in a desired nose, nearly all patients have asymmetric nostrils preoperatively. Ethnicity, trauma, cocaine use, or previous rhinoplasties are some factors affecting the width and shape of the nasal base. After the conclusion of all planned rhinoplasty sequences and closure of the mid-columellarincision, we mark the midline inferior to the columella at the nasolabial junction and use acaliper to measure an equal distance from the mid-columellar point to the alar creases on eachside, and mark the medial points of the alar creases. Next we draw on the natural creasesbilaterally extending to 3 o’clock on the right side and 9 o‘clock on the left side as the limit ofthe lateral excisions to avoid scarring. We then gently depress the alae and alar-facial grooveswith the index finger and allow the formation of new creases superior to the original alarcreases in order to detect excess skin to remove. After marking, the resection was performed with a no. 15 blade. The excision was closed using 6-0 Prolene sutures. We aimed to describe a simple technique for making asymmetric resections in which theapplication of pressure by a finger reveals excess skin in both nostril sill and nostril flareindependently for each alar base. With these asymmetric excisions from the right and left alar bases, a more symmetric nostrils and nasal base can be achieved. Level of Evidence: Level IV, therapeutic study.