Alar Base Reduction Research Articles

A New Alar Base Reduction Technique in Rhinoplasty.

Alar base reduction is one of the most challenging parts of rhinoplasty because the maneuvers that are performed during this procedure are nearly irreversible. Some of the important complications of alar base reduction are notching, scarring and unnatural results. In this study, we present a modified alar base reduction technique in order to prevent these complications. Seventy-five female patients (46 bilateral and 29 unilateral alar base reductions) who needed alar base reduction were operated on consecutively between January 2016 and June 2022 with this new technique. They were compared retrospectively with 67 female patients (41 bilateral and 26 unilateral alar base reductions) who were operated on consecutively with the classical alar base reduction technique between 2010 and 2015. Scar quality was assessed with a modified Stony Brook Scar Evaluation Scale (MSBSES). Three people assessed the overall appearance (resulting in naturalness and symmetry) with a Visual Analog Scale (VAS). Statistically significant differences were found between classical alar base reduction and modified alar base reduction techniques (p<0.05) according to SBSES scores. Also, VAS scores about the result of naturalness were statistically different between the two groups (p<0.05) (Cronbach's alpha value 0.796). There was no significant difference between the VAS scores of the two groups in terms of symmetry (p>0.05) (Cronbach's alpha value 0.828). This new modified alar base reduction technique is found to be useful, easy to apply and has better results than the classical alar base reduction technique. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Internal Incision and Suturing Technique for Alar Base Reduction and Alar Lifting

Internal Incision and Suturing Technique for Alar Base Reduction and Alar Lifting

Application of Modified V-Y Advancement Flap in Alar Base Reduction.

A variety of techniques for alar base modification have been described in the literature. Limitations of these techniques include scars, recurrence, asymmetry, etc. An incorrect excision of the lateral alar wall can result in a tear-drop or Q-shaped deformity. In this study, a modified V-Y advancement flap will be introduced that will avoid the complications discussed above as well as adjust the positional relationship between the nasal alar and the columella using this technique. In addition, this method is reversible; once the nostril is narrow due to excessive advancement of the flap, the reverse V-Y advancement method can be used to enlarge the nostril. In this study, a retrospective review of wide nasal bases in the past 3 years was conducted. A blind analysis of anthropometric points was conducted. There were 3 outcome variables: the width of the alar base, the width of the flare, and the distance between the alar base and columellar base. The alar base was reduced with a modified V-Y advancement flap on 65 female patients ranging from 18 to 45 years of age. In 10 cases, an "Inclined Y-arm flap" was used to narrow alar bases and adjust columella-alar positions. In the remaining cases, a "Horizontal Y-arm flap" was performed to narrow the simple nasal alar width. In all cases, the nasal base was reduced without distortion. In the postoperative period, all the effects were seen to persist for a long time, and patients were generally satisfied with the results of the procedure. By using this modified V-Y advancement flap technique, the incision can be concealed as thoroughly as possible, thereby avoiding "tear-drop" or "Q" deformities as well as narrowing the nasal alar effectively. Furthermore, this method, in combination with rhinoplasty surgery, will greatly enhance the nasal appearance.

Modified Alar Base Reduction: A Novel Technique.

Alar base reduction (ABR) surgery is one of the rhinoplasty techniques used to reduce alar flaring, nasal base width, or both. It is crucial for rhinoplasty surgeons to understand and analyze the type of nasal base deformity to achieve satisfactory results and avoid complications. The objective of this study is to describe a novel technique of ABR that addresses alar flaring while avoiding violation of the nostril marginal rim. This prospective cohort study included patients with alar flaring who underwent rhinoplasty or septorhinoplasty with ABR using our modified technique. Demographic data, clinical history, aesthetic concerns, and preoperative and postoperative photographs were collected for each patient. The surgical outcome was assessed using subjective scar evaluation scores at 3 and 6 months, the Stony Brook Scar Evaluation Scale at 6 months, and an overall appearance satisfaction score. A total of 8 patients were included in the study. Subjectively, the majority of patients (75%) reported satisfactory scar appearance at the 6-month follow-up. The mean Stony Brook score was 4.7 (SD=0.74). Nostril symmetry was achieved in all patients. Seventy-five percent of the participants expressed satisfaction with the overall appearance. Our modified ABR technique demonstrates promising results in correcting alar flaring while achieving nostril symmetry with an acceptable scar. Further studies with a larger sample size are needed to evaluate the feasibility of the technique and compare it to other classical techniques. Level IV.

Evaluation of the Functional and Aesthetic Outcomes of Alar Base Reduction in Patients of Primary Open Septorhinoplasty

Evaluation of the Functional and Aesthetic Outcomes of Alar Base Reduction in Patients of Primary Open Septorhinoplasty

Complications of alar base reduction in Asians

Complications of alar base reduction in Asians

Comparison of scar outcomes of alar base and columella using irradiated polyglactin 911: a single-blind study

Aim: The formation of scars on the face after open septorhinoplasty (SRP) with alar base reduction may disturb the patient due to cosmetic concerns. This study aimed to compare scar outcomes of the columella and alar base in patients undergoing SRP.&#x0D; Material and Method: Twenty-seven patients who underwent alar base reduction during primary open SRP were divided into two groups according to the intervened area as the Columella (CLM) group (n=27) and the Alar Base (AB) group (n=27). Irradiated polyglactin 911 was used in all patients. The modified Stony Brook Scar Evaluation Scale (SBSES) and a questionnaire form were used to measure scar outcomes and patient satisfaction. Columellar and alar base scar outcomes were compared.&#x0D; Results: Patient satisfaction and scar outcomes were better in the CLM group. There was no significant difference, except for the first month total SBSES scores, between the CLM and AB groups. There was no significant difference in patient questionnaire scores between groups. In the early period, there were more signs of inflammation in the alar base than in the columella, without statistical significance.&#x0D; Conclusion: Patient satisfaction and scar outcomes in the columellar area were favorable. Scar outcome on the alar base was statistically significantly worse than columella in the early period. There was no statistically significant difference between both areas in the long-term. Irradiated rapid vicryl can be used for closure of the alar base and columella, considering its advantages and disadvantages, in patients undergoing open septorhinoplasty with alar base reduction.

Reducing the Alar Base While Minimizing Visible Sequalae: A Review of Three Alar Base Reduction Techniques over 35 Years.

Importance: Although classically described and routinely performed, alar base reduction remains nuanced without consensus as to the gold standard. Objective: To compare the measurement of alar base reduction among three techniques and the incidence of postoperative dermabrasion in rhinoplasties performed for 35 years. Methods: A retrospective cohort study of patients who underwent rhinoplasty with alar base reduction between 1983 and 2020 by one surgeon. Dermabrasion rates for visible incisions were evaluated based on patient demographics and surgical technique. Results: Of 312 patients, 82% (258) were women. The mean age was 33 years (SD 11.9). Patients self-identified as White (54.5%), Hispanic (22.4%), African American (8.3%), Middle Eastern, (5.2%), Asian (4.8%), Indian (2.2%), Mediterranean (1.3%), or unspecified (1.3%). Alar flare reduction was used alone in 202 (64.7%) patients. Eighty-two (26.3%) patients underwent postoperative dermabrasion to visible incisions. Patients self-reporting Middle Eastern race were offered dermabrasion at a rate 3.7 × higher than other race groups (OR = 3.73, CI 1.23-11.194, p = 0.02). Conclusion and Relevance: Alar flare reduction, sill reduction, and V-to-Y advancement are techniques that can be used to narrow the alar base. Visible incisions are the most common downside but can be addressed with postoperative interventions including dermabrasion.

Alar Base Reduction with Y-V Sill Flap.

Rhinoplasty is one of the most common surgical intervention among all surgeries in esthetic and plastic surgery procedures. The alar bases have important roles in terms of overall appearance of the nose and the functionality but the research so far which focused specifically on alar base surgery can be considered as insufficient. In the present study, the author aims to demonstrate the beneficial effects of performing Y-V flaps in reduction of the alar base during preservation rhinoplasty procedures. The present study was designed as a retrospective. The inclusion criteria consisted of the following: having a preservation rhinoplasty, having an intervention to alar base during rhinoplasty, and being willing to share the medical data and images for medical purposes. According to inclusion and exclusion criteria, the data of 223 patients were screened. The Rhinoplasty Outcome Evaluation (ROE) scores was found between 80 and 100 points after 1 year. The initial ROE score increased significantly after 12 months of surgery (P<0.001). Rate of satisfaction was excellent in 89.76% according to ROE scale. Present alar base reduction method will present an easy way for alar base reduction procedures related to the Y-V flap. This method will serve a simple and safe way for surgeons for reducing alar base and obtaining better cosmetic and functional results during rhinoplasty surgeries. Level of Evidence: Level III, therapeutic study.

Nasal sill augmentation: an overlooked concept in rhinoplasty\u2014a technical note and review of the literatures

BackgroundNasal sill is one of the components of the alar ring, affecting the esthetic outcomes of rhinoplasty; accordingly, we developed a novel technique to adjust defects in this area and compared it with the available techniques.MethodsOur technique was based on creating a tunnel access to the nasal sill area through an incision made in the lower third of the columella using the open approach or through a nostril base incision in patients, who underwent alar base reduction, followed by insertion of a cartilaginous graft into the marked defect area.ResultsA total number of 54 patients with a defect in the nasal sill area were included in this study. Thirty-one patients underwent open rhinoplasty with the sill approach from the lower third of the columella, while 23 patients underwent rhinoplasty with a nostril base approach for nasal sill augmentation procedure. There were no reports of patient dissatisfaction, infection, bleeding, sensory dysfunction, or remaining asymmetry of the sill area.ConclusionBased on the findings of the present study, this technique can be successfully used in reconstructing the nasal sill area with minimal complications and morbidity.

Alar Flare Preservation Using the Sandwich Technique as an Adjunct to Alar Base Reduction.

Background:Achieving an aesthetic balance and natural appearance when modifying soft tissues of the nasal tip, alae, and nostrils is fundamental to the success of rhinoplasty surgery. The present study aimed to investigate the ability of a simple “sandwich” technique combined with external alar base reduction to preserve the alar flare and achieve a natural and appealing alar contour.Methods:The study included 40 patients who reported dissatisfaction due to excessive nasal flaring. Cartilaginous grafts were harvested from the septum in cases of primary rhinoplasty. Grafts were harvested from the conchal cartilage in cases of secondary rhinoplasty to ensure adequacy of the grafts. The grafts were inserted from the alar wedge excision point along the created pocket to be “sandwiched” in the soft tissue of the alar rim.Results:The average preoperative alar flare was 35.2 mm (SD ±1.9 mm), with an average postoperative reduction of 3 mm. Difference between intercanthal distance and postoperative alar flare distance showed a mean of (−0.4 mm) (SD ±1.2 mm) and was highly significant with P < 0.05. A comparison between nasal base width and alar flare measurements was done. Difference between nasal base width and preoperative alar flare distance was (−9.2 mm) (SD ±2.6), and between nasal base width and postoperative alar flare was (−6.3 mm) (SD ±2.1). Postoperatively, overall patient satisfaction was scored 4.1 of 5.Conclusion:The use of a trapezoidal graft, in combination with external alar base reduction, markedly improves the basal view while maintaining the natural alar flare and curvature.

Comparison Between Using Monocryl Suture and Polypropylene Suture in Closure of Alar Base Excision in Rhinoplasty.

Rhinoplasty is one of the most common procedures that act as a challenge for consistent outstanding results. Alar base reduction is a technique of rhinoplasty that is prescribed in many conditions. Wound closure requires using of sutures and there are several types of sutures for this purpose; however, good scar results are necessary for patients'satisfaction. To evaluate alar base resection scar results after surgical resection using different types of suturing material. This is a retrospective cohort study that was conducted at King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia. The study was performed by reviewing patient's records and performing post-operative photography for patient who underwent alar base resection. The patients were divided into 2 groups, the first group of patients had the alar base wound closed with interrupted Polypropylene 6/0 and the other group wound was closed with monocryl 6/0 sutures. Visual analog scale was used to investigate basal views. The study included 80 patients divided into 2 groups, each group included 40 patients, in the first group (Polypropylene group) there were 25% males and 75% females, whereas in the second group (monocryl) there were 15% and 85% males and females, respectively. There were 85% and 82.5% unnoticeable scar reported by the first and second group, respectively; however there was no significant difference between the 2 groups (P = .75). Both Polypropylene and monocryl sutures result in the same result for closing alar base wound post surgically.

New Concepts in Nasal Tip Rhinoplasty.

Cosmetic rhinoplasty involves surgical manipulation of the nasal cartilages, nasal bones, lining mucosa and extracartilaginous soft. The nasal tip is a complex composite arrangement of tissues. These structures are responsible for creating individuality and asymmetries and for controlling nasal air entry and valving. Medical aesthetics involves filling relevant areas of the tip with hyaluronic acid to disguise grooves or soft defect contour defects. Standard tip surgery involves an open or closed approach. Manipulation of the flexible alar cartilage using intracartilaginous and interartilaginous sutures is preferable to resection, and alar base reduction is becoming more prevalent.

Alecgrama®: Técnica segura para Alectomia – relato de caso.

Descrever uma técnica segura para redução de base alar, através ressecção da pele, diminuindo a distância inter-alar melhorando a harmonia nasal no conjunto facial. Detalhamentos de Caso: Ao longo dos anos as técnicas cirúrgicas têm evoluído muito, e não é o contrário com a Alectomia, cujo propósito é diminuição de largura da base alar. O objetivo principal foi apresentar o resultado de um caso clínico de Alectomia feito através da técnica de Alecgrama® de Algarve &amp; Oliveira (diagrama de redução das asas nasais sem comprometer a estética e função do nariz), deixando-o mais harmônico com o perfil do paciente. Foi realizada a metodologia com a descrição detalhada do caso clínico realizado, com os benefícios de contribuir indiretamente para um grupo de indivíduos que se encontra na mesma situação. Foram relacionados aspectos ainda não observados na literatura. A metodologia bibliográfica foi utilizada com revisão da literatura pertinente com base em buscas através do MEDLINE, EMBASE, LILACS e SciELO. Conclusão: A técnica cirúrgica do Alecgrama®, mostrou-se eficaz para atender os objetivos da cirurgia e dos pedidos da paciente. A reconstrução nasal através da diminuição da base alar utilizando-se procedimento adequado e minimante invasivo, atingiu as expectativas e foi condizente com o resultado funcional e estético, sem processo de inflamação e com cicatrização apropriada, mesmo com a complexidade da estrutura nasal.

Modification of the Basal View after Internal Alar Reduction

Background: Numerous alar base modification techniqueshave been reported in the literature. Specifically, three different techniques were described to manage cases with alar flaring in addition to a wide nasal base. Tissue excision from the alarlobule as well as from the inside of the nostril is executed todecrease the alar flaring and the nostril width, respectively.Further techniques include cinching sutures that help advancethe alae together and flap advancement.The aim of this study is to emphasize the aesthetic impactof the basal nasal view and to reach a maximum aestheticresult concerning nasal alar flare.Patients and Methods: A prospective study was conductedon 25 patients. All patients had alar flaring seeking alarreduction, either alone or as a part of a full rhinoplasty. Duringrhinoplasty, alar base reduction was done at the end of rhinoplastysurgery, after the closure of all rhinoplasty incisionsand after osteotomy was done. A caliper was used to sharplystab the skin from the lateral limb to the desired sill creaseto determine the medial limb of the triangular wedge to beexcised. The base of the triangular wedge was directed downwardand the apex was directed intra-nasally.Results: The current study showed that the internal alarresection significantly decrease the alar flare; as the inter-alardistance ranged between (35-43mm), Mean±SD (39.2±2.3)before surgery and becomes between (31-37mm) Mean±SD(34.8±2.0) after the surgery, with a significant improvement(p-value: <0.001).Conclusion: Internal alar resection effectively reducedthe alar flare, and improved the nostril shape and width. Thistechnique was also useful to retain symmetry of nostril shape,hide the scars internally in the nose, avoid the injury of thelateral nasal artery, preserve the natural curvature of alar rimand avoid detachment of the alar foot plate. This techniquecan effectually be applied to all patients with alar flarereduction

Evaluation of Scar Outcome After Alar Base Reduction Using Different Surgical Approaches

Alar base reduction was first performed in 1892, when Robert Weir began performing surgery to correct nasal flaring.Our study objective was to investigate scar outcomes after alar base reduction with different surgical approaches. We performed a retrospective cohort study of patients who underwent alar base reduction at King Abdulaziz University Hospital. The primary predictor variable was wound incision in the alar-facial groove; other variables were age, gender, and time interval. The outcome variable, scar status, was assessed subjectively (unnoticeable, noticeable but acceptable, or noticeable and unacceptable) and objectively by rhinoplasty surgeons using Stony Brook Scar Evaluation Scale scores. Paired t tests were used, with P≤.05 considered statistically significant. A total of 70 patients were included, with 35 in each of 2 groups. The incision for alar reduction was placed in the alar-facial groove in group 1; the incision was placed 1 to 2mm anterior to the alar-facial groove in group 2. Group 1 consisted of 14 men (40%) and 21 women (60%); group 2 consisted of 8 men (22.9%) and 27 women (77.1%).The average Stony Brook Scar Evaluation Scale scores for groups 1 and 2 were 4.62 and 4.48, respectively, and did not differ significantly (P=.196). During subjective scar assessment, 85.7% of patients from group 1 reported that their scars were unnoticeable whereas 14.3% reported that they were noticeable but acceptable. In group 2, 82.9% of patients reported unnoticeable scars whereas 17.1% reported noticeable but acceptable scars. Thus, no significant differences were observed in the subjective assessment between the 2 groups (P=.286). Alar resection along the alar-facial groove ensures better scar outcomes and hides the scar within that groove, especially in patients with a deep facial groove. Future studies should focus on the best method for limiting scarring in patients without deep facial grooves.

The cinch suture nasal sill excision combination technique for nasal base reduction in rhinoplasty

Alar base reduction is a procedure of balance between multiple structures of the lower nasal vault. This study aimed to describe the alar cinch suture nasal sill excision combination technique and to present our consecutive patient series. The cinch suture nasal sill excision combination technique is described in a step-by-step fashion and illustrated by pre-, post-, and intra-operative photographs, as well as videos. A study of consecutive patients presenting for primary rhinoplasty who required bilateral alar base reduction from October 2016 to October 2019 was performed. A total of 21 patients with a minimum of 12 months post-operative follow-up were included in the study. There were no major or minor complications. The technique involves dynamic manipulation of the nasal base structures and is highly applicable to every alar axis. The cinch suture nasal sill excision combination technique is a simple and durable technique for alar base reduction. It provides predictable outcomes while allowing for control of the lower nasal vault structures. Level of evidence: LeveI IV, therapeutic study.

Updated Dynamics of Rhinoplasty: A Review of the Literature and Comprehensive List of the Findings

The cardinal reason accounting for the complexity of rhinoplasty is that each maneuver during this operation has both intended and unintended effects. The purpose of this report is to review the literature and update the dynamics of rhinoplasty. PubMed searches were conducted for "rhinoplasty dynamics" as well for keywords associated with each specific rhinoplasty maneuver. Titles were evaluated for relevance, and duplicates were consolidated with years of publication 1991 to 2019. Article types include case series (retrospective and prospective), cohort studies, and review articles. Beginning with the radix, its reduction apparently elongates the nose and widens the intercanthal space, while radix augmentation creates the opposite illusions. In a similar manner, dorsal hump reduction widens both the nose and intercanthal space. Nasal tip dynamics focus on the aftermath of changes to tip projection, width, and rotational position. Resection of the upper lateral cartilages can cephalically rotate the tip and reduce tip width. Manipulation of the footplates of the medial crura primarily influences the columella but can also affect tip projection. Placement of a columellar strut firmly establishes tip position. Placement of alar rim grafts advances the ala caudally, widens the nostrils, and elongates the short nostril. Alar base reduction can create the illusion of increased tip projection. Augmentation and reduction in the anterior nasal spine influence tip projection, upper lip length, and the nasolabial angle. As rhinoplasty techniques continue to evolve, surgeons undertaking this operation must continue to reassess the dynamics of various maneuvers. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Horizontal animation deformity as unusual complication of neurotoxin modulation of the gummy smile

Injections of botulinum toxin type A represent the most common nonsurgical cosmetic treatment worldwide. The authors report a case of dynamic horizontal wrinkling in the upper lip that appeared after botulinum toxin type A injections to treat gummy smile associated with nasal alar base reduction, in a 28-year-old woman. The anatomic features and pathogenic mechanism underlying this unusual complication are analyzed and discussed.

Alar Cinching with Subcutaneous Flaps: A Procedure to Achieve Narrowing of the Nasal Base while Controlling the Alar Axis and Sidewall Curvature.

Insufficient narrowing of alar width, alar distortion, and noticeable scarring are commonly encountered after alar base reduction. The authors aimed to demonstrate an alar cinching with subcutaneous flaps procedure to reduce the alar width while controlling the alar axis and sidewall curvature. A retrospective chart review of 560 patients who underwent alar base reduction between 2000 and 2015 was performed. The clinical outcomes of alar cinching with subcutaneous flaps were compared to those of vestibular floor excision with cinching suture. Mean change in alar width was compared to assess narrowing efficacy between the two groups. In addition, mean changes in interalar distance for the upper, middle, and lower parts of the alae were compared to evaluate the alteration of alar axes. Seventy-three patients who underwent alar base narrowing alone (alar cinching with subcutaneous flaps, n = 42; vestibular floor excision with cinching suture, n = 31) were identified. Alar cinching with subcutaneous flaps was significantly more effective than vestibular floor excision with cinching suture in reducing alar width. In patients with vertical alar axes, alar cinching with subcutaneous flaps achieved more uniform narrowing of the entire alae, resulting in prevention of alar distortion. The incidence of complications after alar cinching with subcutaneous flaps was 5.7 percent. Alar cinching with subcutaneous flaps achieved sufficient narrowing of the nasal base in the long-term follow-up in patients with any type of alar axis and enabled the reduction of sidewall curvature while eliminating the need for wedge resection. Therapeutic, III.