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Original Investigation |

Aesthetic Outcomes of Alar Base Resection in Asian Patients Undergoing Rhinoplasty ONLINE FIRST

Ji Heui Kim, MD, PhD1; Joon Pyo Park, MD1; Yong Ju Jang, MD, PhD1
[+] Author Affiliations
1Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
JAMA Facial Plast Surg. Published online July 21, 2016. doi:10.1001/jamafacial.2016.0800
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Importance  Combined sill and alar excision is a useful procedure for correcting a wide nasal base and flared alar lobules. However, the aesthetic outcomes of this technique remain poorly reported.

Objective  To evaluate the aesthetic outcomes of combined sill and alar excision in Asian patients undergoing rhinoplasty.

Design, Setting, and Participants  A retrospective cohort study of 73 consecutive patients who underwent combined sill and alar excision from March 1, 2004, to January 31, 2013, was conducted at a tertiary referral hospital in Korea.

Exposure  Combined sill and alar excision.

Main Outcomes and Measures  Changes in the ratio of the interalar distance to intercanthal distance and frequencies of alar flaring, nostril symmetry, and nostril shape, as measured by reviewing photographs taken before and after the surgery.

Results  Among the 73 patients (50 men and 23 women; mean [SD] age, 36.5 [12.3] years) the mean (SD) ratio of interalar distance to intercanthal distance changed significantly from 1.07 (0.11) to 1.04 (0.08) (P < .001). Of the 60 patients with alar flaring, 45 (75%) no longer had flaring after the procedure. The frequency of nostril symmetry increased from 38 patients (52%) to 46 (63%) (P < .001). The frequency of horizontally shaped nostrils decreased from 21 patients (29%) to 2 (3%), while the frequency of the preferred pear-shaped nostrils increased from 20 patients (27%) to 35 (48%) (odds ratio, 1.16; 95% CI, 0.63-2.14; P = .02). There were 4 cases of complications, namely, alar deformity (1 patient [1%]), unsatisfactory correction of asymmetrical nostrils (1 [1%]), and unsatisfactory correction of alar flaring (2 [3%]).

Conclusions and Relevance  Combined sill and alar excision was a useful technique with a low complication rate for correcting wide alar base, alar flaring, nostril asymmetry, and nostril shape.

Level of Evidence  4.

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Figure 1.
Surgical Methods Involved in Combined Sill and Alar Excision

A, Excising skin inside the vestibule. B, Suturing the vestibule and ala. C, Appearance when sutured.

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Figure 2.
Measurement of Interalar Distance and Intercanthal Distance

A, Distance before surgery. B, Distance after surgery. IA indicates interalar distance and IC, intercanthal distance.

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Figure 3.
Preoperative and Postoperative Photographs of a 29-Year-Old Male Patient

A, Preoperative view of the patient’s alar flaring and horizontal-shaped nostrils. B, Combined sill and alar excision followed by multilayered tip grafting improved the alar flaring and changed the horizontal-shaped nostrils into pear-shaped nostrils without alar flaring.

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Figure 4.
Postoperative Complications

Unsatisfactory correction of alar asymmetry.

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