• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.4
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• pp.287-294
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• 2006

The secondary correction of cleft lip nasal deformity (CLND) presents difficult surgical problems. Characteristically, nostrils are asymmetric. The present study was aimed to examine and compare the effect of Straith's alar web Z-plasty, Millard's alar web Z-plasty, alar web excision, and lateral V-Y advancement of the alar base for augmentation of the nostril with or without lengthening the columella in CLND. The subjects were 28 patients with unilateral cleft lip, who had secondary nostril correction. The nostril correction methods were Straith's alar web Z-plasty, Millard's alar web Z-plasty, alar web excision, and lateral V-Y advancement of the alar base. Facial photographs were taken before and 20 days after the operation. By using Adobe photoshop, the columella length and the nostril width were measured from the facial frontal photograph and Worm's eye view. The degree of improvement was calculated and statistically analyzed. The degree of improvement of the columella length using Straith's alar web Z-plasty was 70.20%. And then Millard's alar web Z-plasty was 55.01%, alar web excision was 39.93%, and lateral V-Y advancement of the alar base was 16.38% in order. The degree of improvement of the nostril size using lateral V-Y advancement of the alar base was 55.26%. And then alar web excision was 52.72%, Millard's alar web Z-plasty was 34.86%, and Straith's alar web Z-plasty was 16.06% in order. Straith's alar web Z-plasty and Millard's alar web Z-plasty resulted in elongation of the columella, equalization of asymmetrical nostril, and enlargement of small nostrils. Alar web excision enlarged nostrils and restored symmetry. Lateral VY advancement of the alar base increased nostril width and enlarged nostrils. These results indicate that the correction of nostrils improve the shape and the symmetry of the nostrils in CLND.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.66-74
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• 2009

Purpose: The importance of the deformities in alar - columellar complex has been underestimated in Asian ethnic groups for the last decades. Fortunately, with increasing familiarity of the open rhinoplasty techniques, the anatomic details of the nasal tip have been pointed up. Definitely, having an interest and demand for improving the sub - normal relationship between the alar rim and columella are indebted for such growing of knowledge about nasal tip anatomy. However, it is true that any single procedure is not settled as versatile and fully confident modality to correct the retracted notching of the alar rim. With this article, I should like to propose another useful option for treating retracted ala. Methods: The author has tried to correct alar rim retraction by means of: (1) Triangular onlay septal cartilage graft on the lower lateral cartilage with the medial end fixed to the anterior surface of the lateral crus(Alar extension graft), (2) Inserting lateral end of the alar extension graft to the vestibular skin pocket in the form of a finger - in - groove, (3) using the vestibular skin in the form of an advancement flap, and (4) using the soft shield graft to prevent possible visible step - off of the alar margin. Results: The author applied an alar extension graft to 16 patients in order to correct a retracted ala for the last 27 months (August, 2003 - October, 2005). The distances from alar rim to long axis of nostril were improved to be within 2 mm in all of the cases, and also the shape of the alar rim changed to a round form. Nostril asymmetry (6%) in one case, temporary palpable step - off (18%) in three cases, temporary visible step - off (6%) in one case, and temporary paresthesia of the tip (25%) in four cases were observed. Conclusion: The alar extension graft is simple and efficacious. It does not need donor sites other than the operative field, and its results are predictable. In particular, since it may give structural intensity to a weak lower lateral cartilage, it may be preferentially used for the correction of a retracted ala that arises from hypoplastic lower lateral cartilage. Moreover intensified lower lateral cartilage also improves the esthetic shape of lobule.

• Archives of Plastic Surgery
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• v.33 no.3
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• pp.269-275
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• 2006

This study is to provide details of the unique anatomical features on the alar lobule region in Korean nose. We hypothesized that the anatomy of this area differs according to the shape of the alar lobule. Based on the prominence and roundness of alar lobules, they were classified into horizontal and vertical types. A total of 20 fresh cadaver noses(10 for each type) were dissected. The anatomical differences between the horizontal and vertical types were investigated by gross and histologic studies. The alar lobule is composed of three layers, i.e., external skin, muscle, and vestibular skin. Profound differences between the two alar lobule types were evident in terms of the volume of the dilator naris anterior muscle, the insertion of the dilator naris posterior muscle, and the thickness of the external skin at the lateral end of the alar circumference. The horizontal type has a greater volume of dilator naris anterior muscle, an additional insertion of the dilator naris posterior muscle, and thicker external skin at the lateral end of the alar circumference than the vertical type. The Korean nose differs anatomically and morphologically from the Caucasian nose. This study shows that there are anatomic differences between the horizontal and vertical types of alar lobules in Korean nose.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.674-678
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• 2011

Purpose: Straight closure line of classic Weir excision leaves visible scars and makes it difficult to precisely approximate resection margins. Hence this study introduces Park-Weir excision that effectively reduces alar width with minimal alar rim scar by 3-dimensional zigzag incision and properly controls the approximation of edges. Methods: From 2008 to 2010, 14 patients underwent Park-Weir excision, crossed wedge excision on alar rim not exceeding 5 mm in width. Each patient was photographed in the same position. Alar width and columellar height against intercanthal distance was compared preoperatively and postoperatively, using image analysis software. Results: Five patients were female and nine were male. Average follow up period was 8 month. Alar width was reduced by 50.50% to 45.96%, original alar width reduced by 8.98% without significant changes in columellar height which was reduced by 0.39%. No visible scar was reported during outpatient follow-up. Conclusion: Park-Weir excision effectively reduces alar width and corrects the flaring of alar without affecting the columellar height. Zigzag incision of Park-Weir excision leaves aesthetically more pleasant scar than straight single incision of classical Weir excision.

• Archives of Plastic Surgery
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• v.43 no.6
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• pp.564-569
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• 2016

Background Alar retraction is a challenging condition in rhinoplasty marked by exaggerated nostril exposure and awkwardness. Although various methods for correcting alar retraction have been introduced, none is without drawbacks. Herein, we report a simple procedure that is both effective and safe for correcting alar retraction using only conchal cartilage grafting. Methods Between August 2007 and August 2009, 18 patients underwent conchal cartilage extension grafting to correct alar retraction. Conchal cartilage extension grafts were fixed to the caudal margins of the lateral crura and covered with vestibular skin advancement flaps. Preoperative and postoperative photographs were reviewed and analyzed. Patient satisfaction was surveyed and categorized into 4 groups (very satisfied, satisfied, moderate, or unsatisfied). Results According to the survey, 8 patients were very satisfied, 9 were satisfied, and 1 considered the outcome moderate, resulting in satisfaction for most patients. The average distance from the alar rim to the long axis of the nostril was reduced by 1.4 mm (3.6 to 2.2 mm). There were no complications, except in 2 cases with palpable cartilage step-off that resolved without any aesthetic problems. Conclusions Conchal cartilage alar extension graft is a simple, effective method of correcting alar retraction that can be combined with aesthetic rhinoplasty conveniently, utilizing conchal cartilage, which is the most similar cartilage to alar cartilage, and requiring a lesser volume of cartilage harvest compared to previously devised methods. However, the current procedure lacks efficacy for severe alar retraction and a longer follow-up period may be required to substantiate the enduring efficacy of the current procedure.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.287-292
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• 2005

The definitive correction of secondary lip nasal deformities is a great challenge for plastic surgeons. To rectify the secondary lip nasal deformities, various procedures and its modifications have been reported in many centers. However, no universal agreement exist to correct the various components of secondary nasal deformities. The secondary nasal deformity of the unilateral cleft lip has its own characteristic abnormalities including the retroplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, short columella, depressed alar base and so forth. Among these components of secondary nasal deformity, maxillary hypoplasia, especially in the area of piriform aperture, and alveolar bone defect can make the alar base depressed, which in turn, leads to wide and flat nasal profile, obtuse nasolabial angle coupled with subnormal nasal tip projection in aspect of aesthetic consideration. Moreover, the maxillary hypoplasia contributes to reduced size of the nasal airway in combination with other component of external nasal deformity and therefore the nasal obstruction may be developed functionally. Therefore, the current authors have performed corrective rhinoplasty with the augmentation of alar base with various methods which include rearrangement of soft tissue, vertical scar tissue flap and use of allogenic or autologous materials in 42 patients between 1998 and 2003. The symmetric alar base could be achieved, which provides the more accurate evaluation and more appropriate management of the various component of any coexisting secondary nasal deformity. In conclusion, the augmentation of alar base, as a single procedure, is a basic and essential to correct the secondary lip nasal deformities.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.3-9
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• 2021

Background For an attractive and natural tip contour in Asian rhinoplasty, insertion of a nasal implant and reinforcement of the cartilaginous framework are essential. However, scar contracture, which often results from augmentation with implant insertion and inadequate soft tissue coverage of the framework, is one of the most common causes of alar retraction. This study reports a novel method of redraping soft tissue along the alar rim to prevent alar retraction in Asians. Methods Twenty young Asian men who underwent primary rhinoplasty with septoplasty were retrospectively reviewed. After the usual rhinoplasty procedures, alar rim redraping was conducted for the soft tissue along the transcolumellar and bilateral infracartilaginous incisions. The longest axis of the nostril (a) and the height of the nostril from that axis (b) were measured in anterior-posterior and lateral views. The preoperative and postoperative ratios (b/a) were analyzed using the paired t-test. Results All 20 patients showed natural contours of the nasal tip, nostrils, and alae after a mean follow-up of 53.6 weeks (range, 52-60 weeks). The ratio of the nostril axes significantly decreased postoperatively in all patients except one, by an average of 11.08%±6.52% in the anterior-posterior view and 17.74%±8.49% in the lateral view (P<0.01). There were no complications, including asymmetry, contracture, subdermal plexus injury, flap congestion, or infection. Conclusions A quantitative analysis of alar retraction by evaluating the ratio of nostril axes showed that alar rim redraping is a simple and effective adjuvant technique for preventing alar retraction in rhinoplasty for young Asian men.

• Archives of Craniofacial Surgery
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• v.24 no.6
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• pp.260-265
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• 2023

Background: The traditional nasolabial V-Y advancement flap is widely used for midface reconstruction, particularly for the lower third of the nose and upper lip, as its color and texture are similar to these areas. However, it provides insufficient tissue to cover large defects and cannot restore the nasal convexity, nasal ala, and adjacent tissues. The purpose of this study is to investigate the modified nasolabial V-Y advancement flap with extension limbs the along alar crease for the reconstruction of complex midface defects. Methods: A retrospective analysis of 18 patients, who underwent reconstruction with the modified nasolabial V-Y advancement flap, was performed between September 2014 and December 2022. An extension limb was added along the alar crease, adjacent to the defect area, and was hinged down as a transposition flap at the end of the advancement flap. Results: The extension limb along the alar crease successfully covered large and complicated defects, including those of the ala, the alar rim, the alar base, the nostrils, and the upper lip, with minor complications. Conclusion: The alar crease is a good donor site for the reconstruction of large and complex nasal and upper lip defects.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.376-382
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• 2011

Purpose: In patients with unilateral cleft lip and nose deformity, alar retraction is commonly seen on the non-cleft side after cleft side is corrected. Spacer graft was used to drag down the inferior border of the alar cartilage of the non-cleft side so as to match the cleft side. By performing spacer graft and septal extension graft together, symmetry and cosmetic improvements were achieved. Methods: Seven unilateral cleft lip and nose deformity patients underwent surgery for alar retraction correction. The median age was 24 years (ranged from 15 to 34 years), and the median follow-up period was 7.4 months (ranged from 6 to 12 months). The perpendicular length from the longitudinal axis of the nostril to the alar rim, the nasolabial angle and the ala-labial angle were measured in the lateral view photo. The longest perpendicular length from the cephalic border of the alar rim to the parallel line of the alar base was measured in the frontal view photo. Results: Improvement in alar retraction was seen after the surgery. There were no specific complications during the follow-up and the symmetry of both nostrils was satisfactory. No increase in the nasolabial angle or exposure of the nostrils was seen after the tip projection via tip plasty. Conclusion: The fundamental factor in correcting alar retraction with secondary cleft lip and nose deformity is repositioning the alar rim with spacer graft, which seems to be more physiologic than other methods. The method combining spacer graft with septal extension graft will bring symmetry as well as more cosmetic improvement in correction of alar retraction with secondary cleft lip and nose deformity.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.24 no.1
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• pp.4-12
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• 2015

Purpose: Due to the presence of various muscles around lips, variety of facial expression can be made and changes from aging process such as wrinkles can develop on the facial skin by the action of multiple muscles. In animals, skin and muscles are developed in the entire body. On contrast, they are well developed only in the face and just one is present in the neck and the palm. Alar band was defined as outer wrinkle formed by zygomaticus minor muscle, which is common in Koreans. This study aimed to investigate clinical prevalence of alar band. Materials & Methods: Subjects were chosen from 780 new patients who visited private clinic in Gyeonggi province for orthodontic treatment. Presence of alar band was examined from the smile extraoral photos. Correlation among skeletal form, lip protrusion, gender, and age were evaluated. Results: Prevalence of alar band was higher in women (27.9%) than in men (18.5%) with statistical significance (p<0.05). With respect to age, prevalence of alar band was 19.4% in age 0-9 y, 16.9% in age 10-19 y, 31.2% in age 20-29 y, 39.5% in age 30-39, 56.5% in age 40-49. Prevalence was gradually increased from patients in their 20s to patients in their 40s and statistical significance was found (p<0.001). Concerning SN_NP, prevalence was 26.2% in normodivergent facial type, 22.0% in hyperdivergent facial type, and 32.2% in hypodivergent facial type. Hypodivergent facial group had higher prevalence but statistical significance was not observed. Statistically significant difference was not found regarding upper lip. However, prevalence of the alar band was 26% in patients with normal lower lip, 14.7% in patients with pretruded lower lip, and 33.3% in retruded lower lip. The prevalence was higher in patients with retruded lower lip with statistical significance (p<0.05). Conclusions: 27.8% on previous anatomical study and this study showed 27.8% prevalence of alar band in clinical smile photographs. Clinical photograph study showed that alar band was more prominent in women, older people, and people with retruded lips with statistical significance. This will provide valuable diagnostic information for esthetic consideration.