Chapter 10 - SLIDING ALAR FLAP

More substantial alar reduction with medial repositioning is effected with a generous in ­ cision above the alar—facial junction with various degrees of alar excision (Fig. 4). Reduc ­tion of the volume, curve, and flare of both the internal and external alar margins will re­ sult from this procedure, the extent of each dependent on the angulation of the alar incision. A backcut placed 2 mm above the alar—facial junction allows the alar flap to slide medially, narrowing the alar base significantly.

Figure 4. Sliding alar flap typically incorporates a backcut to allow the alar sidewall to ad­vance medially.

PEARLS

•  When performing alar base reduction, the surgeon should err on undercorrecting the deformity to prevent resection of excessive tissue. Once too much tissue is ex ­cised, it is very difficult to correct; be particularly conservative in male patients.

•  Internal alar base excision can significantly decrease the internal diameter of the nostril and should be performed in a conservative manner. When performed, usu ­ally <2 mm of tissue is removed.

•  If an incision is made on the lateral surface of the ala, the incision should be made above the alar crease to minimize scarring. A cyanoacrylate adhesive (Der- mabond; Ethicon, Somerville, NJ, U.S.A.) can be used to close the lateral alar in­cision.

•  In the incision, the skin edges can be favorably beveled to maximize skin-edge eversion and avoid a depressed scar.

REFERENCES

1. Tardy ME, Patt BS, Walter MA. Alar reduction and sculpture: anatomic concepts. Facia/ P/a.rl Surg 1993:9: 295-305.
2. Becker DG, Weinberger MS, Greene BA. Tardy ME. Clinical study of alar anatomy and surgery of the alar base. Arch Ofolaryngol Head Neck Surg 1997;123:789-795.