Alar Flare Preservation Using the Sandwich Technique as an Adjunct to Alar Base Reduction

Abstract

Background: Achieving an aesthetic balance and natural appearance when modifying soft tissues of the nasal tip, alae, and nostrils is fundamental to the success of rhinoplasty surgery. The present study aimed to investigate the ability of a simple “sandwich” technique combined with external alar base reduction to preserve the alar flare and achieve a natural and appealing alar contour. Methods: The study included 40 patients who reported dissatisfaction due to excessive nasal flaring. Cartilaginous grafts were harvested from the septum in cases of primary rhinoplasty. Grafts were harvested from the conchal cartilage in cases of secondary rhinoplasty to ensure adequacy of the grafts. The grafts were inserted from the alar wedge excision point along the created pocket to be “sandwiched” in the soft tissue of the alar rim. Results: The average preoperative alar flare was 35.2 mm (SD ±1.9 mm), with an average postoperative reduction of 3 mm. Difference between intercanthal distance and postoperative alar flare distance showed a mean of (−0.4 mm) (SD ±1.2 mm) and was highly significant with P < 0.05. A comparison between nasal base width and alar flare measurements was done. Difference between nasal base width and preoperative alar flare distance was (−9.2 mm) (SD ±2.6), and between nasal base width and postoperative alar flare was (−6.3 mm) (SD ±2.1). Postoperatively, overall patient satisfaction was scored 4.1 of 5. Conclusion: The use of a trapezoidal graft, in combination with external alar base reduction, markedly improves the basal view while maintaining the natural alar flare and curvature.

Modified Alar Base Reduction: A Novel Technique

“…Various techniques have been described to minimize scars, with varying degrees of success. [13][14][15][16][17] Internally hiding the incision in the vestibule, as described by Joseph, can result in alar rim notching. 14,15,18 Modifying the inclination, location, and tissue removal amount of the incision line can help reduce scar visibility.…”

Analysis of Inferior Nasal Morphology and Nostrils following Le Fort I Osteotomy

“…Although the bottom view is not always seen during social interaction, the head’s movement while smiling, drinking, or eating makes this view visible. With selfie photography by smartphones and social media taking their place in our daily lives, the bottom view of the nose has gained importance for evaluating the nose 14,15. Also, some undesirable situations following orthognathic surgery, such as alar flaring, may be more visible at the bottom view rather than the frontal view.…”

“…Besides these dimensional studies about nostrils, nostril shape characteristics differed from each race 5,15,21. Sazgar et al5 categorized nostrils as triangular, bean, and oval.…”

“…Besides these dimensional studies about nostrils, nostril shape characteristics differed from each race. 5,15,21 Sazgar et al 5 categorized nostrils as triangular, bean, and oval. Mori et al 23 classified nostrils as teardrop type, heart-shaped type, round type, and triangular type.…”

“…With selfie photography by smartphones and social media taking their place in our daily lives, the bottom view of the nose has gained importance for evaluating the nose. 14,15 Also, some undesirable situations following orthognathic surgery, such as alar flaring, may be more visible at the bottom view rather than the frontal view. Because of these reasons, the measurements in this study were made over this view.…”