Facial Plast Surg 2018; 34(03): 337-338
DOI: 10.1055/s-0038-1653984
Letter to the Editor
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Tips for the Management of the Wide Nasal Base

Xiaona Lu
1   Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Fei Fan
1   Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
› Author Affiliations
Further Information

Publication History

Publication Date:
01 June 2018 (online)

Adjusting the shape of nasal base shape is a challenge for rhinoplasty surgeons. Recent nasal base reduction articles suggest that some surgeons prefer the incision method to reduce the nasal base width. The resulting scars on nasal base, the asymmetric appearance, and the secondary misshapen nostril, however, need more attention. Thus, we would like to present our methodology for the management of nasal base width.

In our practice, we prefer a transfixing mattress suture, using 4–0 absorbable sutures, to narrow the nasal base ([Fig. 1]). We begin the suture on one side of the nasal columella root in the intramuscular plane. We then cross the base of the nasal columella, remaining intramuscular, and emerge inside the nostril at the inner wall of the contralateral nasal ala. From here, we place the suture back into the intramuscular plane, turn the suture in the opposite direction, cross the nasal columella once again, and emerge on the inner wall of the opposite alar rim (ipsilateral to where the suture began). We turn the suture back again in the opposite direction and emerge approximately at the site where the entire stitch began at the side of the nasal columella root. We tension the suture to achieve the level of narrowing desired, and we place the knot. With this method, it is easy to balance the shape of the bilateral alar rims and nostril by just tensioning the suture, while avoiding scars at the same time.

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Fig. 1 The transfixing mattress suture method in nasal base narrowing.

Our primary concern with the incision method is the scar, particularly prominent when the nasal base reduction is performed simultaneously with a rhinoplasty. The exposed scars in the nasal sill are inevitable. However, based on the anatomy, the scars are parallel to the elongated nasal columella ([Fig. 2]), which can reduce the tension of the wound, resulting in a relatively acceptable scar long term. Unfortunately, the incisions made on nasal alar rim are still an issue. Based on similar distortion or strain, the scars on the alar rim are more visible due to the longer columella, though they can be hidden in the lateral alar contour to a certain extent ([Fig. 3]).

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Fig. 2 The nasal sill scars are parallel to the elongated nasal columella.
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Fig. 3 The scars on the alar rim are more visible due to the longer columella, though they can be hidden in the lateral alar contour to a certain extent.

The major disadvantage of our method is the eventual relapse of wide nasal base compared with the more stable incision method. The final width lays somewhere between that of the unoperated nasal base and that achieved with the incision method. To compensate, we tend to overcorrect the nasal base width using the suture method, and we anticipate the final outcome to stabilize around 6 months postoperatively. Furthermore, our patients have expressed more concern with asymmetric and misshapen nostrils than insufficient nasal base reduction. All outcomes considered, the transfixing mattress suture method may present a better option.

In conclusion, we recommend the transfixing mattress suture method to reduce the width of nasal base when performed together with a rhinoplasty.