Alar reductions in rhinoplasty

Abstract

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.