Chapter 10 - Alar Base Resection
Follow the accompanying figures and text to perform alar base resections (1,2).
The site of incisions and the amount, degree, and geometry of alar reductions depend on a host of anatomic variations predetermined before and during surgery. Although the sur geo n ' s aesthetic judgment will ultimately determine the site and degree of resection, a more precise surgical approach may be determined if several anatomic guidelines are assessed and integrated. Conservatism is mandatory to avoid overreduction and asymmetry, condi tions that are difficult to correct satisfactorily.
As the need for reduction increases, both the incision and excision become more exten sive. Alar reduction is a compromise operation, in which greater reductions exact the penalty of a larger scar. The surgeon must balance this compromise with experienced aes thetic judgment and proven scar-camouflage techniques.
Skin sutures placed across the alar-facial junction often lead to permanent suture marks. Effective camouflage at the alar-facial junction may be facilitated by positioning incisions 1 mm to 2 mm above the alar-facial junction. Skin closure can he performed with a cyanoacrylate adhesive (octyl-2-cyanoacrylate, Dermabond; Ethicon, Somerville, NJ, U.S.A.).
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