Alar reductions in rhinoplasty.

OBJECTIVE

To ascertain if avoiding the vestibular portion of alar reductions during rhinoplasty could improve the cosmetic result of the postoperative nasal sill.

DESIGN

Blind, randomized review of base-view photographs (40 patients) 1 year after rhinoplasty.

SETTING

A surgical clinic, accredited by the Accreditation Association of Ambulatory Health Care.

PARTICIPANTS

A consecutive sample of 40 patients (2 groups) who underwent alar reduction as a part of their rhinoplasty and whose 1-year postoperative photographs were reviewed by 2 facial plastic surgeons and 3 plastic surgeons.

MAIN OUTCOME MEASURES

Midway through a 2-year period, the method of alar reduction was changed to include only the cutaneous portion of the nostril. Twenty-two patients had cutaneous-vestibular excisions; 18 patients had cutaneous-only excisions. The surgeon participants reviewed randomized photographs taken 1 year postoperatively and were asked to rate the alar sill for the degree of scarring and notching.

RESULTS

Tabulation of the surgeons' ratings revealed significantly less perception of notching and scarring in the alar reduction group with the cutaneous-only excisions.

CONCLUSION

Modification of alar reduction to avoid crossing the nostril rim appears to improve the aesthetic result.