• Archives of Plastic Surgery
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• 제33권3호
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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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• 제38권5호
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• pp.669-673
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• 2011

Purpose: The authors have conducted a series of anatomic studies on the factors affecting shape of a lower vault in Asian noses. The results of the studies showed that prominence of alar lobule is mainly affected by the volumes of the dilator naris anterior and posterior muscles and the insertions of the dilator naris posterior muscles. However, information on its clinical availability is yet insufficient. The present study was undertaken for clinical purpose to find out the effect of dilator naris muscle resection on the correction of prominent alar lobule. Methods: Six patients who were treated by dilator naris muscle resection with a long-term follow-up of more than 1 year were involved in this study. Rhinoplasties were performed via endonasal approaches with resecting dilator naris anterior and posterior muscles by sharp scissor. The effect of the dilator naris muscle resection on alar prominence was investigated by measuring ratio of the short axis to the long axis of a nostril (SA/LA) pre-and postoperatively. The visual analog scale (VAS) was also used to evaluate satisfaction of patients. An average follow-up time was $15.6{\pm}3.7$ months. Results: Having lost the dilating and lateral pulling effects of the dilator naris muscles, the alar lobule shifted medially and alar lobule shapes improved. SA/LA significantly improved (preoperatively $0.71{\pm}0.11$ and postoperatively $0.58{\pm}0.08$; $p$ <0.05). The VAS score was also increased postoperatively (preoperatively $3.2{\pm}1.8$ and postoperatively $8.7{\pm}1.2$; $p$ <0.05). A mild degree of hyperpigmented scar was noted in one alar lobule. Otherwise, there was no case of postoperative complication. Conclusion: Our results suggest that prominent alar lobule could be modified by resecting the attachment of the dilator naris muscles. This maneuver removes the function of dilator naris muscles, then may produce a more aesthetically acceptable alar lobule shape.

• Archives of Plastic Surgery
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• 제36권1호
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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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• 제32권2호
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• pp.205-213
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• 2005

There are several characteristics of the nose of orientals. The dorsum of nose is flat and low, the skin is thick with severe tension, the nasal tip is bulbous, the nostril is wide, and the projection of the nose is limited due to a poorly developed alar cartilage with a short columella. In order to improve these untoward characteristics of the nose of Orientals aesthetically, plain augmentation of the dorsum and tip-plasty with conventional methods has been performed by many plastic surgeons. However these conventional rhinoplasty is not enough to obtain satisfactory results when transforming into a more beautiful and aesthetically charming appearance. In order to produce the optimal nasal shape and profile, it is extremely important to consider the aesthetic surgical factors, which are; the position of the nasion, the optimal nasolabial angle(95-100 degree in Orientals), the natural exposure of infra-tip lobule with and columella, the position of the tip defining point in harmony with the dorsal profile and the smooth and natural silhouette of the lateral nasal profile as it descends into the inferior portion of the nose. From April, 2003 to August, 2004, a total of 52 patients underwent open rhinoplasty, adhering to the strict aesthetic principles considered and described priorly. Surgical approach was done through a transcolumella incision and an alar rim incision. The nasal dorsum was augmented with a silicone implant and the shape of the columella and the nasolabial angle were finessed with a silicone strut implant which was placed in between the medial crurae in a manner of a non-visible graft. The nasal tip was corrected by alar cartilage suture technique and onlay graft of shield shaped Alloderm and Gore-Tex. Author obtained the optimal nasal shape and profile aesthetically, and the results, considered satisfactory in all patients without any complications, are as follows; 1. the average increase in nasal length was 2.5 mm, 2. the average decrease in nasal width was 2.1 mm, 3. the average increase in nasal tip projection was 3.2 mm, 4. the changes of nasolabial angles were from 85.5 degree to 94.7 degree, 5. the changes of the angle between the long axis of the external naris was from 101.3 degree to 89.5 degree. In conclusion, this surgical procedure is an effective, reliable and a valuable method in improving the nasal shape, tip projection, nasolabial angle and especially, the lateral facial profile of Orientals aesthetically.