Correcting the Alar Base Retraction in Crooked Nose by Dissection of Levator Alaque Nasi Muscle

Abstract

Careful analysis to identify the deformity and proper selection of the technique will ensure a pleasing outcome. The new techniques presented for the correction of nasal base retraction and prevention of the recurrence of the dorsal deviation will help rhinoplasty surgeons obtain pleasing outcomes.

Correction of Alar Base Retraction by Levator Labii Alaeque Nasi Muscle Dissection and Alar Rim Grafting: A Clinical Prospective Study

“…Alar base retraction is a retraction of the horizontal part of the alar sulcus cephalically. It is usually confused with alar retraction, which is characterized by more than 2 mm alar rim retraction in the long axis of the alar rim to the nostril [3,6].…”

“…LLANM has two insertions: medially into the lateral nostril and laterally into the upper lip, in which the lateral part raises and evert the upper lip, while the medial part retracts the alar rim laterally and superiorly to dilate the nostrils. This muscle is innervated by the zygomatic and superior buccal branches of the facial nerve and supplied by the facial artery and the infraorbital branch of the maxillary artery [3,4].…”

“…Alar base retraction is defined as a cephalic elevation of the alar margin, which may result in excess nostril show and aesthetically unsatisfied surgical results [3]. In order to correct that, there are some excisional and repositioning procedures that can be done; however, these procedures may result in nostril distortion or stenosis as well as elevating the upper lip instead of releasing the alar base caudally if corrected with excisional procedures [5].…”

Functional and Aesthetic Outcomes of Asymmetric Dorsal Preservation for Correction of I-Shaped Crooked Nose Deformity

“…Various techniques have been described for the correction of CND ( 11 , 12 , 13 , 14 , 15 ); however, most of them are associated with high revision rates. Many surgeons have emphasized the importance of septal surgery in the management of CND ( 16 , 17 ).…”

Evidence-Based Dynamics in Rhinoplasty

“…22 Classically manipulation of the DSN is believed to help this deformation, but transecting levator labii superioris alaque nasi muscle has also been reported to help with the plunging tip and reduce gummy smile. [22][23][24][25] The overlying soft tissue envelope contributes to the varying projection and definition of any lower lateral cartilage maneuvers in those with thin versus thick sebaceous rich skin. 26 In order to account for the dynamics of thick nasal skin, techniques such as removing fat overlying and between the domes, creating a firm cartilaginous frame, trimming redundant nasal skin, reducing the tip frame width, and eliminating dead space using the supratip stitch may be indicated.…”