[Alar and columellar refinement in rhinoplasty].

This paper emphasizes the value of surgical techniques of nasal sculpturing with special attention to the structural details in primary and secondary rhinoplasty to achieve a perfect aesthetic as well as functional result. The marginal resection of the alae and the columella allows the appropriate reduction adapting the nostril contour to the new proportions of the nose at the end of a rhinoplasty or to equalize the height of the alar rim in cases of harelip nose. In order to perfect the nasal contour, we also introduce cartilaginous onlays into the anterior part of the columella emphasizing the lobulo-columellar double-angle in a harmonious profile. In case of moderate fibrocicatricial retraction of the alar border, a vestibular advancement flap is dissected through the inter-cartilaginous incision and a thin cartilage graft fills the loss of tissue as a spacer. It is then held in place using transalar mattress sutures. Important losses of alar tissue necessitating composite graft are not especially considered in the paper which essentially concerns refinement procedures. The finesse of the latter seems to be indispensable to adapt the alar-tip-columellar complex to the bony structures of the nose and to ensure the harmonious equilibrium of the rhinoplasty.