Alar reductions in rhinoplasty
S. E. Gilbert
Department of Otolaryngology, University of Oklahoma Health Sciences Center, Tulsa, USA.
OBJECTIVE: To ascertain if avoiding the vestibular portion of alar
reductions during rhinoplasty could improve the cosmetic result of the
postoperative nasal sill. DESIGN: Blind, randomized review of base-view
photographs (40 patients) 1 year after rhinoplasty. SETTING: A surgical
clinic, accredited by the Accreditation Association of Ambulatory Health
Care. PARTICIPANTS: A consecutive sample of 40 patients (2 groups) who
underwent alar reduction as a part of their rhinoplasty and whose 1-year
postoperative photographs were reviewed by 2 facial plastic surgeons and 3
plastic surgeons. MAIN OUTCOME MEASURES: Midway through a 2-year period,
the method of alar reduction was changed to include only the cutaneous
portion of the nostril. Twenty-two patients had cutaneous-vestibular
excisions; 18 patients had cutaneous-only excisions. The surgeon
participants reviewed randomized photographs taken 1 year postoperatively
and were asked to rate the alar sill for the degree of scarring and
notching. RESULTS: Tabulation of the surgeons' ratings revealed
significantly less perception of notching and scarring in the alar
reduction group with the cutaneous-only excisions. CONCLUSION: Modification
of alar reduction to avoid crossing the nostril rim appears to improve the
aesthetic result.
