Aesthetic Outcomes of Alar Base Resection in Asian Patients Undergoing Rhinoplasty

Overview

Combined sill and alar excision narrows a wide nasal base and corrects nostril wings that flare outward, but its results had been poorly documented. The authors reviewed 73 consecutive patients treated at a tertiary referral hospital in Korea between March 2004 and January 2013, measuring changes from photographs taken before and after surgery.

Sections of note

• Retrospective cohort of 73 consecutive patients, 50 men and 23 women, mean age 36.5 years.
• The ratio of the distance between the nostril edges to the distance between the inner corners of the eyes fell from 1.07 to 1.04, p less than 0.001.
• Of 60 patients with alar flaring, 45 (75 percent) no longer had it after surgery.
• Nostril symmetry rose from 38 patients (52 percent) to 46 (63 percent), p less than 0.001.
• Horizontally shaped nostrils fell from 21 patients (29 percent) to 2 (3 percent), while the preferred pear shape rose from 20 (27 percent) to 35 (48 percent), odds ratio 1.16, p = 0.02.
• Four complications: one alar deformity, one unsatisfactory correction of asymmetric nostrils, two unsatisfactory corrections of flaring. Level of evidence 4.

What it means for a patient

• The procedure narrowed the base of the nose and changed the shape of the nostril openings, not only their width.
• Three quarters of patients with flaring had it corrected, meaning one quarter did not.
• The measured narrowing was small in absolute terms, from a ratio of 1.07 to 1.04, though consistent enough to be statistically significant.
• Retrospective, single centre, no comparison group, and outcomes graded from photographs rather than reported by patients.

Why this paper matters

Alar base surgery leaves external scars and cannot easily be reversed, so knowing how reliably it works matters before agreeing to it. Putting rates on flaring correction, symmetry and nostril shape gives that. What remains unknown is whether patients themselves judged the change worthwhile.

Terms

• Alar base: the point where the nostril wing meets the face.
• Alar flaring: nostril wings that spread outward, widening the nose.
• Sill excision: removal of tissue from the floor of the nostril to narrow the base.
• Interalar distance: the width across the outer edges of the two nostrils.
• Intercanthal distance: the distance between the inner corners of the eyes, used as a reference.