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Clinical study of alar anatomy and surgery of the alar base
D G Becker1, M S Weinberger, B A Greene
1Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, USA. beckerd@upenn.mail.med.edu
Objectives:
To analyze and quantify specific aspects of alar base anatomy and to identify anatomic configurations that may be correlated with specific surgical manipulations.
Design:
Analysis in a population of patients presenting for aesthetic nasal surgery.
Setting:
Facial plastic surgery practice.
Patients:
The photographic slides of 120 white patients who presented for consultation were reviewed.
Interventions:
On the base view of photographic slides, observations were made on the width of the alar base, recurvature of the alar base, thickness of the alar lobule, thickness of the alar wall, and flare of the alar wall. On the lateral view, observations were made on the vertical insertion of the ala on the face (cephalic, normal, or caudal), contour of alar rim in profile (gentle S-shape or straight), size of alar lobule (small, normal, or large), and alar-columellar relationship, with special attention to the presence of alar hooding.
Main Outcome Measures:
A spreadsheet program was used to analyze the incidence of each configuration and any association between various features of the alar base.
Results:
Anatomic diversity exists that requires a careful individual analysis for each patient. A planned surgical intervention must fit the patient's unique anatomy. Distinctive configurations of recurvature, vertical insertion, and other aspects of the alar base were observed, with special implications for the surgeon's approach.
Conclusions:
Anatomic diversity requires a thorough preoperative examination followed by selection of an approach that addresses the specific anatomic findings. The choice of the best alar reduction and sculpture technique ultimately relies on a precise analysis of the anatomic configuration of the patient's alar base.