Abstract

BACKGROUND:
Open septorhinoplasty is one of the most challenging procedures in facial plastic surgery and consideration must be given to both facial aesthetics and nasal function.
OBJECTIVE:
To evaluate the functional and the aesthetic outcomes of alar base reduction techniques in patients of primary open septorhinoplasty.
PATIENTS AND METHOD:
A prospective, descriptive study had been conducted from the first of  April 2018 to the first of April 2019 at the Center of Otolaryngology- Head and Neck surgery at Ghazy AL-Hariry Medical City Hospital, 40 patients were selected (28 females and 12 males) who underwent primary open septorhinoplasty. All patients were evaluated by questionnaire, subjective assessment, clinical examination and photo documentation both pre and post-operatively quantitatively analyzed using image J processing software for objective assessment, with follow up at first, third and sixth month post-operatively and three types of operations techniques were used to reduce the wide nasal base.
RESULTS:
Among the 40 patients, the mean ratio of inter-alar distance to inter-canthal distance changed significantly from (1.234) to (1.034), the frequency of nostrils symmetry increased from (18) patients to (33) patients, the frequency of nasal flaring decreased from 30 patients to only 7 patients, the mean width of the internal vestibular resection was 3.675 mm and the mean width of the external alar wedge resection was 4.45mm. All the patients were satisfied in varying degrees and no worsening of the functional outcomes postoperatively assessed subjectively.  No cases of postoperative bleeding, infection, vestibular stenosis, keloid, hypertrophic scar formation or nasal obstruction were encountered.
CONCLUSION:
A conservative excision is preferred to a radical one because it is a simple matter to resect additional alar tissue than reconstruct a stenotic ala. Alar base reduction techniques are effective techniques for patient with wide alar base and/or alar flaring with good outcomes regarding patients’ satisfaction and without worsening of the functional outcomes. The internal vestibular floor resection that is inclined 30-45 degrees laterally together with placement of the external alar resection in the natural alar facial crease result in natural curvature of the alar rim and an inconspicuous scar.