Online Contents

 Animations

In this Chapter Online at experconsult.com

Excision of Excess Nostril Sill Animation 12.1

Excision of Excess Nostril Sill and Alar Base Animation 12.2

Design of an Excision of Excess Lateral Alar Base Animation 12.3

Excision of Excess Lateral Alar Base Animation 12.4

Pearls

An imbalanced alar base is a common feature of an ‘operated nose’.^1–3 This incongruity may manifest as flaring nostrils with a wide alar base that was not corrected during the primary rhinoplasty, alar base asymmetry, or, even worse, an alar base that was improperly reduced, thus eliminating the graceful transition from ala to nostril sill and causing a displeasing angulation at the junction of the alar base with the upper lip. This deformity can be difficult to correct. It is therefore essential to evaluate prudently the alar base abnormalities and plan the surgical correction with the utmost precision in order to avoid these undesirable outcomes. Additionally, understanding the dynamic interplays germane to the alar base surgery is absolutely crucial. This portion of the rhinoplasty should not be considered trivial and the role that the alar base surgery plays in the success of rhinoplasty is greater than is usually realized.

Anatomy and Pathology

Recognition of alar base disharmony is the most important step in establishing a pleasing relationship between the base, the rest of the nose, and the face. The distance from the lateral limits of one alar base to the opposite side is approximately 2 mm wider than the intercanthal distance in a harmonious face. This is true as long as the intercanthal distance is optimal (normally 31–33 mm; Figure 12.1). Should the intercanthal distance be judged to be abnormal, the orbital fissure (the distance from the medial to lateral canthus) can be used as a guide to decide the width of the alar base. For analysis of this zone, as was discussed in Chapter 3, a vertical line dropped from the medial canthus in a nose with an optimal alar base should pass 1 mm medial to the outer boundary on each side of the alar base, as long as the intercanthal distance is normal.

Figure 12.1 Two vertical lines (lines L and R) should pass 1 mm medial to the outer boundary of the optimally positioned alar base (as long as the intercanthal distance is normal).

The vertical alar base position is readily determined on the profile view (Figure 12.2). Point N (nasion) is connected to point S (stomion) and the distance is divided equally into three. The caudal border of the alar base is located 2 mm caudal to the junction of the middle and lower thirds.

Figure 12.2 Analysis of vertical alar base disharmony on the profile view. Point N (nasion) is connected to point S (stomion) and the distance is divided equally into three. The caudal border of the alar base is located 2 mm caudal to the junction of the middle and lower thirds.

Alar base deformities can include horizontal excess (Figure 12.3), horizontal deficiency (Figure 12.4), or vertical malposition, which is either caudal (Figure 12.5) or cephalad (Figure 12.6

Related posts:

Rhinogenic Migraine Headaches Elongation of the Short Nose Rhinoplasty in Patients with Thick Skin Correction of the Overprojected Nose Secondary Rhinoplasty Patient Assessment for Rhinoplasty

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