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Alar Base/Nostril Reduction Surgery
The nose is a complex, three-dimensional structure, serving numerous necessary functions in life. In addition to functionality, the nose adds beauty or aesthetic appeal to one's face if it is in correct and pleasing proportion to the facial features. A common complaint among ethnic patients seeking Rhinoplasty with Dr. Slupchynskyj is that their nose is just too wide for their face. Excess nasal width can be caused by a variety of factors. In some cases, and more frequently in African American patients, wide nostrils, also known as the alar base, emphasize nasal width. In these patients, nostril narrowing, or alar base reduction, is often indicated to provide an aesthetically complete and balanced result.
Making the nostrils smaller may seem like a relatively straightforward procedure: simply remove a small amount of the nostril and your nostrils are smaller. In fact, nostril narrowing requires meticulous and superior surgical skill, especially when working with African American patients, whose thicker skin is more prone to scarring and can be difficult to manipulate. When nostril narrowing surgery is not performed correctly, the results may include obvious scars and a pinched, distorted and unnatural look. It is critical to select a Board Certified Facial Plastic Surgeon with extensive training and experience in this procedure.
Dr. Oleh Slupchynskyj, a Double Board Certified Facial Plastic Surgeon, has developed a completely unique combined approach to nostril narrowing that addresses the complexities of the African American nose. Dr. Slupchynskyj's surgical technique reduces the nostril size from both a horizontal and vertical perspective, resulting in nostrils that are in harmony with the rest of the face, while maintaining the natural curvature of the nostril and minimizing potential scarring.
What are Traditional Nostril Narrowing Surgical Techniques?
The concept of nostril narrowing was first developed in 1892 by R. F. Weir and is still popular today. The Weir Technique, known as Weir Alarplasty, begins with a crescent shaped incision made at the alar-facial groove, where the nostril meets the cheek. A small beveled portion of the nose is sliced off and then the divided edges are sewn together. See Figure 1. Joseph and Aufricht, augmenting the shape of the excision, have made slight modifications to this technique: Joseph advocated a crescent-shaped excision, while Aufricht described a variety of geometrical forms to be removed from the nostril, including the removal of tissue from the nasal sill. Today, these same techniques are still employed in most nostril narrowing procedures.
How Does Dr. Slupchynskyj's Technique Differ and Offer Superior Natural Results?
Most Rhinoplasty Experts like Dr. Slupchynskyj agree that noses with large nostrils which exhibit large nasal flare must be corrected using a two-pronged approach addressing the horizontal and vertical aspects of the nose (when observing the nasal base view as shown in the diagram above, Figure 1.). Nasal flare is where the nostrils extend outward from the face and beyond the point at which they meet the face. When nostrils on either side of the nose extend beyond the inner corner of the eye, nasal flare is exhibited. The horizontal aspect of the nasal base is often reduced using an intrasill wedge excision and the vertical aspect is typically addressed using a crescent-shaped excision at the alar-facial groove. Figure 2 illustrates both excisions. Dr. Slupchynskyj believes that many African American patients who have a large nasal base and flare may require a version of this combination technique. However, in his opinion, the typical excisions described above require modification to obtain the best possible result.
It is important to note that nostril narrowing should be the last step in any Rhinoplasty procedure where other nasal augmentation is taking place. Corrections to the nasal tip can affect the shape, position and flare of the nostrils. Therefore, it is critical to take all augmentation into account prior to excising tissue from the nostrils to narrow them. Over-excision of tissue is nearly impossible to correct and leaves the patient with an undesirable result.
In seeking to narrow the horizontal aspect of the nostrils, Dr. Slupchynskyj employs the intrasill wedge excision technique. Dr. Slupchynskyj concurs that the wedge excision provides the best opportunity to reduce the nose in the horizontal aspect. Placement and size of the wedge will vary from patient to patient. This excision is shown in isolation below in Figure 3. Note the patient's nostril has already been marked to indicate the size and placement of the wedge to be removed.
The vertical aspect of nostril narrowing is commonly approached by using the crescent-shaped external excision at the alar-facial groove. This excision is isolated below in Figure 4. While the crescent-shaped excision at the alar-facial groove is typically used by many surgeons today, Dr. Slupchynskyj has found the placement of this excision to be problematic, especially in African American patients, who present more complex nasal anatomy. When the tissue at the alar-facial groove is excised, even meticulously, the surgeon has eliminated the natural curve that occurs when an unmodified nostril meets the face. That curve is extremely difficult to replicate and when augmented, it can result in a flattened nostril and an unappealing, pinched triangular shape. The typical justification for excision placement in the alar-facial groove is that the natural crease conceals the minimal scar. However, several studies conducted by surgeons who advocate the use of this excision (Foda, Kridel & Castellano) also mention the need for postoperative dermabrasion to the external scar, particularly in patients with thick, oily skin. Therefore, in Dr. Slupchynskyj's opinion, since African American patients are more prone to scarring and the negative results of an unnatural nostril curve, the rationalization for the use of this excision, especially within that population, does not hold up.
Instead, Dr. Slupchynskyj addresses the vertical aspect of the nostril with an intra-alar excision, just above the alar-facial groove. This excision is shown in Figure 5 and can be compared side by side with the alar-facial groove excision in Figure 4. The nasal tissue is excised within the nostril, leaving the natural curve where the nostril meets the face intact. The excision is not prominently placed, as it is low and very close to the face. Of utmost importance is Dr. Slupchynskyj's meticulous incision, removal of tissue and closure. This cannot be overemphasized. Dr. Slupchynskyj's experience and expert surgical technique combine for a better-looking nostril.
Dr. Slupchynskyj has pioneered a modification to the typical two-fold approach to nostril narrowing to better address the African American nose. Employing the intrasill wedge excision in combination with his superior intra-alar excision seen in Figure 6 below, he is able to provide the most natural of results in the African American patient. See the following before and after photos of just a few of his patients who have had the combination approach to nostril narrowing.