Alar rim deformities

Alar disharmony is one of the most common abnormalities observed after a rh inoplasty. This article describes three classes in addition to Gunter's cla ssifications of alar/ columella deformities, which include concave ala, con vex ala caused by convex lateral crus, and convex ala caused by thick alar tissues. These deformities are best visualized from the basilar view. The d ifferent surgical techniques for correction of true alar abnormalities are presented. The alar convexity, when it is the result of a misshapen cartila ge, is corrected using a lateral crura spanning suture, posterior transecti on of the lateral crura, or transdomal suture. A thick ala, resulting in co nvexity, can be thinned through either a direct incision on the ala or an i ncision in the alar base. A lateral crura strut, an onlay graft, or a rim g raft eliminates the concavity. For a slight retraction, an alar rim cartila ge graft is an optimal choice. For significant alar retractions, the author 's preferred technique is an internal V-to-Y advancement, which is describe d in detail. An elliptical excision of the alar lining will effectively cor rect the hanging ala. These techniques have been used to correct alar disha rmonies on 58 patients. One patient from the V-Y advancement group exhibite d a small area of alar necrosis, and two early patients demonstrated an ove rcorrection; all were easily resolved with revision surgery. By carefully i dentifying nasal base and alar abnormalities, harmony can be established to correct an undesirable appearance.