More substantial alar reduction with medial repositioning is effected with a generous incision above the alar-;facial junction with various degrees of alar excision (Fig. 4). Reduction of the volume, curve, and flare of both the internal and external alar margins will result from this procedure, the extent of each dependent on the angulation of the alar incision. A backcut placed 2 mm above the alar-;facial junction allows the alar flap to slide medially, narrowing the alar base significantly.
Figure 4. Sliding alar flap typically incorporates a back cut to allow the alar sidewall to advance medially.
When performing alar base reduction, the surgeon should err on under-correcting the deformity to prevent resection of excessive tissue. Once too much tissue is ex;cised, it is very difficult to correct; be particularly conservative in male patients.
Internal alar base excision can significantly decrease the internal diameter of the nostril and should be performed in a conservative manner. When performed, usu;ally 2 mm of tissue is removed.
If an incision is made on the lateral surface of the ala, the incision should be made above the alar crease to minimize scarring. A cyanoacrylate adhesive (Der- mabond; Ethicon, Somerville, NJ, U.S.A.) can be used to close the lateral alar incision.
In the incision, the skin edges can be favorably beveled to maximize skin-edge eversion and avoid a depressed scar.
- Tardy ME, Patt BS, Walter MA. Alar reduction and sculpture: anatomic concepts. Facia/ P/a.rl Surg 1993:9: 295-305.
- Becker DG, Weinberger MS, Greene BA. Tardy ME. Clinical study of alar anatomy and surgery of the alar base. Arch Ofolaryngol Head Neck Surg 1997;123:789-795.