COSMETIC

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Alar Cinching with Subcutaneous Flaps:
A Procedure to Achieve Narrowing of theNasal Base while Controlling the Alar Axisand Sidewall Curvature
Toshitsugu Hirohi, M.D.
Donald Ng, M.D.
Koji Nagai, M.D.
Kotaro Yoshimura, M.D.
Tokyo and Tochigi, Japan; and Singapore, Singapore

Background: Insufficient narrowing of alar width, alar distortion, and noticeable scarring are commonly encountered after alar base reduction. Theauthors aimed to demonstrate an alar cinching with subcutaneous flaps procedure to reduce the alar width while controlling the alar axis and sidewall
curvature.
Methods: A retrospective chart review of 560 patients who underwent alar basereduction between 2000 and 2015 was performed. The clinical outcomes ofalar cinching with subcutaneous flaps were compared to those of vestibularfloor excision with cinching suture. Mean change in alar width was compared
to assess narrowing efficacy between the two groups. In addition, mean changes in interalar distance for the upper, middle, and lower parts of the alae werecompared to evaluate the alteration of alar axes.
Results: Seventy-three patients who underwent alar base narrowing alone(alar cinching with subcutaneous flaps, n = 42; vestibular floor excision
with cinching suture, n = 31) were identified. Alar cinching with subcutaneous flaps was significantly more effective than vestibular floor excision
with cinching suture in reducing alar width. In patients with vertical alaraxes, alar cinching with subcutaneous flaps achieved more uniform narrowing of the entire alae, resulting in prevention of alar distortion. The
incidence of complications after alar cinching with subcutaneous flaps was5.7 percent.
Conclusions: Alar cinching with subcutaneous flaps achieved sufficient narrowing of the nasal base in the long-term follow-up in patients with any type ofalar axis and enabled the reduction of sidewall curvature while eliminating theneed for wedge resection. (Plast. Reconstr. Surg. 142: 1165, 2018.)
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Awide alar base is common in East Asians;
however, alar flare is less common than abroad nasal base. A low dorsum and bulbous nasal tip caused by insufficient nasal tip projection exaggerate the apparent width of the alarbase. Alar base reduction surgery is frequently
From the Ritz Cosmetic Surgery Clinic; the Department of
Plastic Surgery, Jichi Medical University; and the Alaxis
Medical & Aesthetic Surgery Clinic.
Received for publication November 14, 2017; accepted May11, 2018.
Presented at the 23rd Congress of the International Societyof Aesthetic Plastic Surgery, in Kyoto, Japan, October 23
through 27, 2016.
Copyright © 2018 by the American Society of Plastic Surgeons
DOI: 10.1097/PRS.0000000000004917

performed to correct bottom-heavy noses among
East Asian patients.
Several surgical techniques are performed foralar base reduction; however, no single method isDisclosure: The authors have no financial interest
to declare in relation to the content of this article.
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