Association of Skin Thickness With Alar Base Reduction in Patients Undergoing Lateral Crural Repositioning and Strut Grafting

Abstract

IMPORTANCE Knowing the operation plan is important for rhinoplasty surgeons to prevent unpredictable results. OBJECTIVES To investigate the frequency of alar base resection in patients with different skin thickness who underwent lateral crural repositioning and lateral crural strut graft and to evaluate the results in the context of the current literature. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series study included 621 patients who underwent primary open septorhinoplasty by the same surgeon between January 1, 2012, and June 30, 2015. From the surgical notes, operation type (lateral crural repositioning [LCrep] with lateral crural strut grafting [LCSG] and with or without alar base resection) and skin type were recorded. Study participants' skin types were determined intraoperatively and divided into 3 groups: (1) thick skin (the tip definition was limited by skin thickness and subcutaneous tissue), (2) thin skin (the tip cartilage was visible and could be observed despite overlying soft tissue and skin), and (3) normal skin (the tip cartilage during the procedure had no effect on the tip definition). MAIN OUTCOMES AND MEASURES No primary study outcome was established before data collection began. The hypothesis was formulated during data collection. RESULTS Of the total 621 patients in the study, 95 (15.3%) were men and 526 (84.7%) were women. Lateral crural repositioning with LCSG was performed in 319 surgical procedures (51.4%), and alar base reduction was performed in 329 (53.0%). The rate of alar base resection differed significantly on the basis of whether LCrep with LCSG was performed (odds ratio [OR], 1.821; 95% CI, 1.324-2.504; P < .001). In patients with thin skin, there was a marked difference in the incidence of alar base resection associated with LCrep with LCSG, but the difference was not statistically significant (OR, 2.034; 95% CI, 0.912-4.539; P = .08). In patients with thick skin, a significant difference in the frequency of alar base resection was associated with the application of LCrep with LCSG (OR, 1.995; 95% CI, 1.228-3.241; P = .005). In patients with normal skin, LCrep with LCSG had no significant association with the frequency of alar base resection (OR, 1.557; 95% CI, 0.930-2.607; P = .09). CONCLUSIONS AND RELEVANCE The necessity of alar base reduction after LCrep with LCSG is greater in patients with thick skin than in patients with thin and normal skin. This study is the first to examine this topic in rhinoplasty. LEVEL OF EVIDENCE 3.

The miniature lateral crural strut graft: Efficacy of a novel technique in tip plasty

“…In thick-skinned subjects, more cartilage grafting is needed for a heavier footprint underneath, increasing the alar spread with concomitant increase in the alar base width 31 and increase in frequency of needed alar base reduction. 32 We agree with previous opinions recommending the use of septal cartilage for its desired strength and straightness; however, the main drawback is the paucity of this source. Other proposed sources of the LCSG include conchal cartilage, rib cartilage, and cephalic LC.…”

“…A sizable graft placed under the LC adds bulkiness that may comprise the external valve, especially when undermining the whole undersurface. In thick‐skinned subjects, more cartilage grafting is needed for a heavier footprint underneath, increasing the alar spread with concomitant increase in the alar base width and increase in frequency of needed alar base reduction …”

Correcting Wide Alar Base and Flare With Combined Sill and Alar Excision in Asian Patients

“…We created the alar incision along the alar-facial groove and sutured the incision with intracutaneous suture techniques, which produced unnoticeable scar and could well hide the scar in the depth of the natural alar crease. This location of incision was in contrast with previous studies, which described the incision be placed above the crease to avoid crease obliteration 12,14–16 . However, obvious scar paralleled to the alar crease may be observed with this incision above the crease.…”

Evaluation of Lateral Crura Divergence Angle of Iranian Candidates for Primary Rhinoplasty

“…15 Several studies introduced LCDA equal to or less than 30 degrees relative to midline as malposition. [16][17][18] Therefore, there was no definitive definition for LCDA in the Iranian population. The results of our study may be useful for Middle East surgeons, because they can be more confident in identifying the complication and use appropriate techniques and maneuvers to address it.…”