(1) Alar wedge excision, (2) nostril sill excision, and (3) combined alar wedge and nostril sill excision. The second disadvantage is the high tendency of developing postoperative alar flaring; hence, some authors 3,14,18 described using alar base narrowing procedures in conjunction with these nasal tip deprojection techniques. Though not routine, specific nasal landmarks may be marked, including the rhinion (keystone), upper lateral and lower lateral cartilages. 27.2 ): Point 1: The lateral-most point is marked at the alar-facial groove. Alar flare reduction marking ( Fig. They should be an integral part of every rhinoplasty evaluation and surgical plan as indicated. In this patient, too much alar flare has been removed, resulting in a straightened lateral ala, and the base reduction incision has violated the internal alar rim. Very significant nose width reduction may need to combine nasal base width reduction (e.g., sill excision) with alar flare reduction. Choosing the alar reduction technique is depended on the size of the reduction, the shape of the nostrils, and the degree of symmetry between the nostrils. Cartilaginous grafts were harvested from . The alar base is the lower portion of the nose that connects to the upper lip and cheek. When deciding on which base reduction techniques will produce the desired outcome, the rhinoplastic surgeon must distinguish be­tween alar flare and alar base width.' Alar flare is the maximum degree of convex bowing of the alar base above the alar crease. Although often inconspicuous, the alar base plays an . Alar base modification (must assess alar . Poor surgical planning or improper correction of alar base disharmonies can be irreversible and can have significant functional consequences. The alar wedge excision is an elliptical excision placed in the alar crease that is used to reduce the size and shorten the vertical length of alar lobule and correct the excessive . Alar base reduction is an important technique for narrowing the frontal view of the nose. We adopted the technique of medial flap alar base planning and per operative assessment of the tip in relation to resection as advocated by Jack Sheen to achieve normal . Alar base reduction is a process in which the width of the base of the nostrils is reduced to give the nose a narrow and proportionate look. Herein, we report our surgical technique and outcome of alar lifting technique for correcting tilted alar base. There are two methods of alar base reduction. A total number of 54 . Alar base reduction. [1,2]Reconstruction of the symmetrical lip and a natural looking nose is a difficult challenge in unilateral clefts. Of these in 5 cases alar base resection was felt necessary after reduction rhinoplasty to correct the flared An approach to alar base requires meticulous pre-operative nostrils. If internal incisions are used, the scar and suture will not be apparent. Candidates for alar base narrowing may have either a predisposition to excess width or a surgically created flaring of the ala as a result of tip deprojection. . In a beautiful face, the width of the alar base equals the gap between the eyes, the so-called glabella. This sail excision could be combined with other alar base reduction techniques (Figure 2, Figure 3). Recent findings: Among the numerous techniques available, the management of cases with wide nasal base and alar flaring remains limited to three options: cinching . When seen from the bottom, It is ideal that the nose looks like an equilateral triangle and the nostrils take up to two-thirds of the total length of the nose. An alar base reduction is a technique that reduces the size of large or glaring nostrils. To describe various techniques, including alar base reduction, alar flaring reduction, and alar hooding reduction and present a decision-making treatment algorithm and quantifiable guidelines for soft-tissue excision, along with scar outcomes from a single-surgeon practice. The alar base is the lower portion of the nose that connects to the upper lip and cheek. Alar base resection is an essential part of rhinoplasty which is frequently utilized to narrow a wide nasal base or to correct excessive flaring of the lateral ala extending beyond the alar-facial groove. Marking incisions for an alar base reduction are typically reserved for the end of the procedure. Schematic drawing shows the Y-to-V alar base reduction technique. nasal base reduction: innovation of the surgical sequence technique dra. . Alar base modification, also known as nostril reduction surgery, is a technique used in rhinoplasty to alter the width, and/or the flare of the nostrils. Because of this, a simple suture technique alone is not adequate to accomplish this goal. Line 1: A curved line in the alar-facial groove is made from Point 1 to Point 3. Historically, alar modifica­ tion has consisted of the removal of tissue from inside Objective: To evaluate the role of the combined alar base excision technique in narrowing the nasal base and correcting excessive alar flare. Alar base reduction is a technique of rhinoplasty that is prescribed in many conditions. A boomerang-shaped alar base excision is described to narrow the nasal base and correct the excessive alar flare. ALAR BASE REDUCTION TECHNIQUES. With this technique, we can narrow the nostrils, reduce nostril flaring, and/or correct asymmetry of the nostrils. The ideal width of the alar base is one-fifth of the facial width. Point 3: A point 2 mm inferior to the sill-base junction is marked. No cases of postoperative bleeding, infection, vestibular stenosis, or nasal obstruction were encountered. Wound closure requires using of sutures and there are several types of sutures for this purpose; however . The classification system is intended to facilitate choosing the best surgical technique to correct… It's the triangular outline you see when looking up at the nose from below. This type of rhinoplasty surgery can make the nose look narrower. 1 Multiple surgical techniques have been described to narrow a wide nasal base, including alar wedge excision, sill reduction, 2 a combination of wedge and sill reduction, 2,3 repositioning . Traditionally, in alar base reduction, the surgeon creates an incision 1 to 2 mm anterior to the alar-facial groove and closes the wound to minimize scarring. . Point 2: The sill-base junction is marked. To simplify the approach and diagnosis of alar base reduction, suggest a treatment algorithm, and evaluate the long-term outcomes of 3 different techniques used separately or in conjunction with . Others throughout the 20th century, however, have refined precise indications for and techniques of alar base reduction and narrowing during rhinoplasty. If a person's nose has a wide alar base (the nostril area), an alar base reduction is a viable solution. All cases were followed up for a mean of 32 . The results can improve nasal symmetry, reduce nostril size […] Alarplasty, also called alar base reduction surgery, is a cosmetic procedure that changes the shape of the nose. 98.3. Line 1: A curved line in the alar-facial groove is made from Point 1 to Point 3. Wedge excision technique is used to preserve the natural curve of the base . Furthermore, it is likely that an alar base reduction is necessary and indicated when the width of the nasal base is 2 mm wider than the intercanthal distance . Also referred to as nostril reduction, this technique may narrow the nostrils, reduce the length of the nostril sidewalls or the overall sized of the nostril, or correct asymmetry of the nostrils. Alar base reduction is an important technique for narrowing the frontal view of the nose. Wedge excision technique is used to preserve the natural curve of the base . The maxillofacial fractures were reconstructed by open reduction and internal fixation. Yet another way to narrow the width of the nostrils is a method known as the V-Y advancement technique. Nowadays, there are many different types of nose surgeries available. At the primary assessment for alar reconstruction, a substantial amount of scar tissue, responsible for retractions, was noticed on her right midface and alar base. Herein, we report our surgical technique and outcome of alar lifting technique for correcting tilted alar base. Methods The medical records of 18 patients with alar base asymmetry who underwent rhinoplasty using the . It is corrected by wedge resection of external alar base (Weir excision). The alar base reduction technique is also highlighted in this view. 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. The primary goal of the treatment in the cleft patients is to restore normal anatomy and function. Regardless, I am always more careful in letting my patients know if they undergo an alar-base reduction that they may require a few steroid/5-fluorouracil (scar dissolver) injections and possibly dermabrasion as well . treating the retracted alar dr. enrico robotti closing dinner coffee break 21:00 12:00- . In other words, when alar base reduction is done incorrectly, a patient can lose the natural curve to the nostril and be left with a very triangular look (think Michael . Facial plastic surgery 4 www.co-otolaryngology.com Volume 24 . There are various techniques for this. This technique is commonly used to treat nostril flaring. Historically, alar modifica­ tion has consisted of the removal of tissue from inside The nasal base is often overlooked during the initial planning of rhinoplasty. Objectives: To simplify the approach and diagnosis of alar base reduction, suggest a treatment algorithm, and evaluate the long-term outcomes of 3 different techniques used separately or in conjunction with one another. Clefts of lip and palate are the most common congenital defects involving the orofacial region. Making the nostrils smaller by reducing the width of the nostrils. Some alar flare is preferable to over resection of it to avoid nostril distortion. The authors discuss anesthesia and their standard approach and provide a detailed step-by-step surgical plan for alar base reduction, flare reduction, hooding reduction, as well as possible complications. To simplify the approach and diagnosis of alar base reduction, suggest a treatment algorithm, and evaluate the long-term outcomes of 3 different techniques used separately or in conjunction with . Although often inconspicuous, the alar base plays an . The study included . This occurs more commonly among Ethnic Rhinoplasty surgery such as African American rhinoplasty, Asian rhinoplasty, Hispanic/Latino rhinoplasty, or Middle Eastern/Mediterranean rhinoplasty surgery. Deciding on the technique used during the surgery is up to the physician. Dr. Purpose of review: The purpose of this article is to further explore the techniques available for alar base reduction by a recent review in this topic, focusing in the current advances in the field, in a clear and readable format. The exact alar reduction technique chosen will be dependent upon the individual anatomy encountered, the aesthetic outcome desired, and the need to camouflage resultant . This study aimed to describe the alar cinch suture nasal sill excision combination technique and to present our consecutive patient series. During an alar base reduction consultation, a plastic surgeon will examine the area to determine the exact reason for the wide nose. Candidates for alar base narrowing mayhave either a predisposition to excesswidth or a surgically created flaring of the ala as a result of tip deprojection. Alarplasty (also known as alar base reduction) is a cosmetic surgery that changes the shape and width of the nostrils. This technique requires precision and will result in: Improved nose symmetry and balance Horizontally long lateral alar wall with/or without alar flaring: This is a very common type of wide alar base among Asians. A multitude of surgical techniques for narrowing the alar base and modifying the nostril shape have been described, including wedge resection, nostril sill resection, the V-Y advancement technique, and the cinching suture technique. To describe various techniques, including alar base reduction, alar flaring reduction, and alar hooding reduction and present a decision-making treatment algorithm and quantifiable guidelines for soft-tissue excision, along with scar outcomes from a single-surgeon practice. This technique is often combined with the wedge technique to reduce alar flare . Alar base reduction is an important technique for narrowing the frontal view of the nose. Background Alar base reduction is a procedure of balance between multiple structures of the lower nasal vault. Schematic illustration of the sail excision technique; (A) represents the planned part to be excised from the vestibule, (B) represents the planned alar base reduction. WEIR "WEDGE" EXCISION. . I have now moved that knowledge over to my technique for alar-base reduction and have noticed a similar tremendous improvement. This is effective when alar is too wide or skin is too thick. Adapted from [3 ]. Nostril Anatomy. Patients ranged in age from 15 to 59 years (mean age, 30.4 years). (b) Postoperative base view with properly corrected caudal septum, tip projection, and base reduction. Intercartilaginous (Technique: cephalic resection of the lateral crus. . Alar base reduction is a rhinoplasty technique which corrects nostrils that are too wide. Point 2: The sill-base junction is marked. Point 3: A point 2 mm inferior to the sill-base junction is marked. The incisions are placed in the natural crease at the base of the nostril which is known as the alar . 1) Incision technique. It's the triangular outline you see when looking up at the nose from below. The internal excision was inclined 30 to 45 degrees laterally to form the inner limb of the boomerang. Many people worry about overly-large nostrils or are concerned about the width or flare. INTRODUCTION. Our techniques rely primarily on precise suture placement and tension control to create a natural-appearing and stable nasal tip contour. In 2007, Foda described the combined alar base excision technique for nasal base narrowing in cases of wide alar base with excessive nasal flare . I have now moved that knowledge over to my technique for alar-base reduction and have noticed a similar tremendous improvement. The images of results, treatments, techniques and clinical situations are mere guidance examples aiming to help the patients in their decision-making process, providing an average overview of Dr. Alejandro Nogueira's work; no one of them can be considered as an obligation of any particular results nor a commitment for the application of any . Several techniques are available to slim wide, flared or thick nostrils using alar base reduction rhinoplasty. Alar base reduction. . Design: Retrospective review of 124 patients seen in a private practice by a single surgeon. Alarplasty (also known as alar base reduction) is a cosmetic surgery that changes the shape and width of the nostrils. These complications did not occur with the alar setback technique, since the domal segments of the alar cartilages were .