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Nasal Base Reduction: A Treatment Algorithm Including Alar Release with Medialization

Gruber, Ronald P. M.D.; Freeman, M Brandon M.D., Ph.D.; Hsu, Charles M.D.; Elyassnia, Dino M.D.; Reddy, Vikram M.D.

Plastic and Reconstructive Surgery: February 2009 - Volume 123 - Issue 2 - p 716-725
doi: 10.1097/01.prs.0000345598.95343.63
Cosmetic: Original Articles

Background: The broad nasal base is occasionally not correctable by excisional procedures alone because nostril distortion or stenosis may result (if resection enters the vestibule). Moreover, recurrence is a common problem when alar mobilization and suture approximation techniques are used. The authors developed an algorithm for nasal base reduction to prevent these complications.

Methods: A new classification of the broad nasal base was utilized that included patients with general nasal base enlargement and patients with a vertically oriented alar axis (traditionally difficult to correct without distortion). Both groups received an alar release including the following: (1) the soft tissues and pyriform ligament of the anterior maxilla; (2) the periosteum posterior to the pyriform rim (in the bony nasal vault); and (3) when necessary, soft tissues along the horizontal pyriform rim. Interalar sutures maintained the alae in their new medialized position. Twelve patients who only underwent alar release were evaluated.

Results: Nasal base reduction was achieved in all cases without distortion. Three patients required release of the horizontal tissues of the pyriform rim (including a condensation of the pyriform ligament). After a follow-up period of 11 months to 3¾ years, there were two cases of partial recurrence and one partial airway obstruction.

Conclusions: Not all causes of a broad nasal base are amenable to resection procedures, especially the generally broad nasal base such as that due to thick skin or a vertically oriented alar axis. However, a tension-free alar release with medialization by suture fixation is effective. The incidence of recurrence can be expected to be reduced.

Stanford, San Francisco, and Davis, Calif.; and Providence, R.I.

From the Divisions of Plastic and Reconstructive Surgery of Stanford University, University of California, San Francisco, Brown University, and University of California, Davis.

Received for publication February 19, 2008; accepted August 4, 2008.

Disclosures: None of the authors has anything to disclose except Ron Gruber, M.D., who designs instruments for Padgett/Miltex/Integra. All royalties go to the Plastic Surgery Educational Foundation.

Ronald P. Gruber, M.D., 3318 Elm Street, Oakland, Calif. 94609,

©2009American Society of Plastic Surgeons