23 May 2015
RHINOPLASTY OVERVIEW – PART 3
There is an integral relationship between the nasal tip and wide nasal alae (nostrils) in Ethnic Rhinoplasty. A bulbous or rounded nasal tip is typically comprised of a flat wide and fatty tip caused by weak tip cartilages, excessive fatty tissue and thick skin in the tip area; these factors not only widen the tip but also lower it, which in turn flares and widens the nostrils.
Alarplasty is a term used for reduction of alar (nostril) width and flaring. This procedure can be performed in several different ways/techniques. Typical ethnic patients are extremely wary of the procedure because results, primarily bad ones, are seen in celebrity Rhinoplasties, specifically in the alar bases of Michael Jackson or Lil Kim's. If not performed correctly, an Alarplasty procedure can result in essentially a flattening or distortion of the nasal facial groove. This type of Alarplasty illustrates the surgeon's attempt to reduce alar flare and hide the incision in the nasal facial groove. Placing an incision in this very location can create flattening or other unnatural curvature of the nasal alae.
Latoya Jackson, Lil' Kim and Michael Jackson
Nostril Narrowing at the Natural Alar-Facial Groove, leading to the "Triangle Nostril" Look
The yellow wedge shown in the photo above indicates where the nostril is narrowed at the Natural Alar-Facial Groove. This causes flattening of the nostril and an unnatural "Rhinoplasty look". See celebrities shown above.
One critical requirement for successful correction of an ethnic bulbous tip involves adding cartilage support structures to the nasal tip and also to and within the columella (portion of the nose between the nostrils). Proper placement of strut grafts, shield grafts and other necessary nasal tip cartilage grafts add structure and form to the tip beneath the subcutaneous skin envelope. This also elevates the tip and pulls the flared nostrils and alar base in a "superior" direction, also known as tip projection. It is crucial to gain elevation in the tip area when correcting a bulbous tip as this elevation raises the skin envelope and creates form and definition within the tip structures. This is demonstrated in the before/after photos looking at the sub-nasal vertex view of ethnic bulbous tip rhinoplasties and revisions.
The combination of nasal tip projection and elevation of the tip reduces the bulbous nature of the tip as well as nostril width or alar flare. During this procedure, the last step to be performed is reduction of alar width and flaring since the nasal tip must be set in the proper tip projection.
This is a 25 year old African American model that was seeking reduction of her bulbous tip and reduction of alar flaring. The approximate location of her flat, thin, lower lateral cartilage is shown in teal. These structures help form the shape of the nasal tip. Dr. Slupchynskyj performed a tip elevation procedure using cartilage strut and shield grafts. The shield graft shape and location is illustrated in orange while the strut graft is shown in blue. The tip was elevated, thus reducing the nasal flaring. In addition, Dr. Slupchynskyj performed an intra-sill horizontal nasal narrowing procedure to reduce the horizontal alar width. The excess fatty fibrous tissue in the nasal tip, shown before in yellow, was removed. This patient also received one dose of subcutaneous Kenalog 40 injection to further reduce scar formation, swelling and bulbously of the tip.
Horizontal Nostril Narrowing with Preservation of the Alar-Facial Groove
Horizontal Nostril Narrowing using Dr. Slupchynskyj's Intrasill Wedge technique, highlighted above in yellow, preserves the Alar-Facial Facial Groove, leading to a leading to a natural-looking and aesthetically pleasing Nostril Narrowing.
