Alar lift: Sail excision technique for alar overhanging in the Middle Eastern Nose

Hussein, Wael K.A.; Elbadan, Hisham E. M.; Shewel, Yasser; Bazak, Remon

doi:10.1016/j.ejenta.2014.09.001

Egyptian Journal of Ear, Nose, Throat and Allied Sciences

2015

DOI: 10.1016/j.ejenta.2014.09.001

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Alar lift: Sail excision technique for alar overhanging in the Middle Eastern Nose

Wael K.A. Hussein

Hisham E. M. Elbadan

Yasser Shewel

et al.

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Cited by 2 publications

(2 citation statements)

References 9 publications

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“…This creates a lifting effect and improves the alar columellar disproportion specially when combined with septal advancement techniques. 6,7…”

mentioning

confidence: 99%

Use of Sail Excision in Alar Morphology Modification of Asian Noses

Regalado,

Yap

2023

Philipp J Otolaryngol Head Neck Surg

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Globular hanging nasal alae, described as convex round shaped alar lobule which may be an aesthetic nuisance in the final result of rhinoplasty, are commonly seen among Southeast Asian noses. Such alar lobule morphology is an important part of nasal aesthetics and should not be disregarded. Surgical techniques used to address a hanging ala include direct external approaches. External rim excision was proposed to address hidden columella, sigmoid alae, small nostrils, dropped rim and foreshortened nose.1,2 Rim tissue was excised in full thickness fashion and sutured in one layer. Others proposed alar groove excision followed by alar repositioning and full-thickness skin grafting to reposition the alar base and correct hanging alae.3 Although these approaches have been proven to correct hanging alae, they leave a visible scar and/or permanent alar rim deformity if not done cautiously, especially on thick skinned patients.1-3 The alar rim may not be natural looking since it is lined by a scar, thus losing the lobular texture of the rim. A vestibular incision has been proposed to correct a hanging ala with unsightly scar.4 A maximum of 3mm elliptical vestibular skin was recommended to be removed to lift the alar rim with significant results. However, this recommendation was based on estimates and surgeon’s experience in western noses and may be insufficient for Asian noses. In addition, performing this technique without specific landmarks is difficult in achieving accurate results, especially when performed by a novice surgeon. Hence, further modification is important to address these concerns. Attempting to address the hanging alae in Asian noses, the senior author (ECY) modified the vestibular incision and came up with the sail excision technique based on the patient’s nasal anatomy.5 By presenting definite landmarks, the technique resulted in an alar lift procedure with reproducible outcomes. Furthermore, after performing sail excision in several patients, the authors noted the effect of this technique on alar morphology. This procedure is done by excising a precisely marked piece of inner nasal vestibular skin that is shaped like the sail of a boat to achieve a symmetrical and redictable result. This creates a lifting effect and improves the alar columellar disproportion specially when combined with septal advancement techniques.6,7 Furthermore, limiting the excision along the inner vestibular area and rolling the alar rim skin inwards results in correction of hanging ala (with a hidden scar) without an obvious, external scar. After performing the technique on several patients, we observed that in addition to its effect on lifting a hanging ala, the sail excision technique also changes the alar morphology from a globular-shaped lobule to a more aesthetically pleasing ridge-shaped lobule. To the best of our knowledge, such an effect of sail excision on alar morphology has not been described in the literature. This article aims to demonstrate the effect of the sail excision technique on alar rim morphology of Asian noses by describing the step-by-step procedure, surgical landmarks, and pearls in performing this technique.

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“…This creates a lifting effect and improves the alar columellar disproportion specially when combined with septal advancement techniques. 6,7…”

mentioning

confidence: 99%

Use of Sail Excision in Alar Morphology Modification of Asian Noses

Regalado,

Yap

2023

Philipp J Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

“…In addition to the thick skin problem, rhinoplasty involves all of the tissues of the external nose, and the individual reactions of these tissues are not always predictable. [7][8][9][10][11][12][13][14][15] The aim of this study is to detect the factors contributing to the development of pollybeak deformity in the Middle Eastern nose and methods used to prevent as well as to treat such deformity.…”

mentioning

confidence: 99%

Pollybeak Deformity in Middle Eastern Rhinoplasty: Prevention and Treatment

Hussein

Foda

2016

Facial plast Surg

Self Cite

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The pollybeak deformity is one of the commonest causes of revision rhinoplasty. The Middle Eastern nose has certain criteria that predispose to the development of pollybeak deformity. The aim of this study is to detect the factors contributing to the development of pollybeak deformity in the Middle Eastern nose and methods used to prevent as well as to treat such deformity. Out of the 1,160 revision patients included in this study, 720 (62%) patients had a pollybeak deformity. The commonest contributing factors included underprojected tip with poor support in 490 (68%) patients, excessive supratip scarring in 259 (36%) patients, overresected bony dorsum in 202 (28%) patients, and high anterior septal angle in 173 (24%) patients. The methods used by the authors to treat the pollybeak deformity are described, along with the local steroid injection protocol used to guard against the recurrence of pollybeak deformity.

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Alar lift: Sail excision technique for alar overhanging in the Middle Eastern Nose

Cited by 2 publications

References 9 publications

Use of Sail Excision in Alar Morphology Modification of Asian Noses

Use of Sail Excision in Alar Morphology Modification of Asian Noses

Pollybeak Deformity in Middle Eastern Rhinoplasty: Prevention and Treatment

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