Pull-Out Suture in the Correction of Alar Rim Deformities

Objectives: This study aimed to investigate the treatment methods used for alar rim problems during the last 5 years and the efficacy of pull-out sutures on the outcomes. Methods: A retrospective study was conducted on patients with alar contour grafting and pull-out suture procedures between 2018 and 2023. Patient records and images, such as retraction or collapse, were evaluated before surgery. The average duration of follow-up after surgery was 26 months, but it may be as long as 5 years. Results: The study enrolled 148 patients, 120 females and 28 males, between the ages of 20 and 44. The distance measured between the alar rim and the long axis of the nostril varied between 3 and 5 mm, with an average value of 3.5 mm. Postoperatively, the exact measurement was performed. However, subjective and objective observational evaluation was preferred for comparison instead of calculating the difference in millimeter due to the minimal change in dimension but significant effects on the outcome. According to patient survey responses, 83.8% of patients (124/148) were satisfied, and 9.5% (14/148) had a moderate response, but 10 cases (6.7%) were not happy with the result. The observational evaluation of the surgeon was very close to the patient's subjective evaluation. We did not have any complications or infections. Conclusion: Postoperative alar retraction may occur due to over-resection of the inner mucosa of the nose or the lower lateral cartilages. Cartilage and mucosal grafts are helpful tools to correct this deformity. Pulling the alar rim's caudal end with a suture prevents the alar mucosa's shrinkage and the alar rim from retracting. The same suture can also help correct retracted alas.