ALAR REDUCTIONS IN RHINOPLASTY

Objective: To ascertain if avoiding the vestibular portion of alar red uctions during rhinoplasty could improve the cosmetic result of the po stoperative nasal sill. Design: Blind, randomized review of base-view photographs (40 patients) 1 year after rhinoplasty. Setting: A surgica l clinic, accredited by the Accreditation Association of Ambulatory He alth Care. Participants: A consecutive sample of 40 patients (2 groups ) who underwent alar reduction as a part of their rhinoplasty and whos e 1-year postoperative photographs were reviewed by 2 facial plastic s urgeons and 3 plastic surgeons. Main Outcome Measures: Midway through a 2-year period, the method of alar reduction was changed to include o nly the cutaneous portion of the nostril. Twenty-two patients had cuta neous-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 r evealed significantly less perception of notching and scarring in the alar reduction group with the cutaneous-only excisions. Conclusion: Mo dification of alar reduction to avoid crossing the nostril rim appears to improve the aesthetic result.