Objectives To describe an alar cartilage–modifying technique aimed at decreasing
nasal tip projection in cases with overdeveloped alar cartilages and to compare
it with other deprojection techniques used to correct such deformity.
Design Selected case series.
Settings University and private practice settings in Alexandria, Egypt.
Patients Twenty patients presenting for rhinoplasty who had overprojected nasal
tips primarily due to overdeveloped alar cartilages. All cases were primary
cases except for one patient, who had undergone 2 previous rhinoplasties.
Intervention An external rhinoplasty approach was used to set back the alar cartilages
by shortening their medial and lateral crura. The choice of performing a high
or low setback depended on the preexisting lobule-to-columella ratio. Following
the setback, the alar cartilages were reconstructed in a fashion that increased
the strength and stability of the tip complex.
Main Outcome Measures Subjective evaluation included clinical examination, analysis of preoperative
and postoperative photographs, and patient satisfaction. Objective evaluation
of nasal tip projection, using the Goode ratio and the nasofacial angle, was
performed preoperatively and repeated at least 6 months postoperatively.
Results A low setback was performed in 16 cases (80%) and a high setback in
4 (20%). The mean follow-up period was 18 months (range, 6-36 months). The
technique effectively deprojected the nasal tip as evidenced by the considerable
postoperative decrease in values of the Goode ratio and the nasofacial angle.
No complications were encountered and no revision surgical procedures were
required.
Conclusions The alar setback technique has many advantages; it results in precise
predictable amounts of deprojection, controls the degree of tip rotation,
preserves the natural contour of the nasal tip, respects the tip support mechanisms,
increases the strength and stability of nasal tip complex, preserves or restores
the normal lobule-to-columella proportion, and does not lead to alar flaring.
However, the technique requires an external rhinoplasty approach and fine
technical precision.
