Online Contents
Animations
Video Content
Effect of the Interdomal Suture Animation 13.1
Effect of an Alar Rim Graft Animation 13.2
Excising Redundant Soft Triangle Lining Video 13.1
Pearls
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The anatomical structures that contribute to the balance of the nasal base include the nostrils, the alar rim, soft triangle, medial crura and footplates.
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The components of a short nostril include a short columella, redundant soft triangle lining, and weak and short ala.
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On the basilar view, the ideal ratio of the infratip lobule length to the nostril length is 40 : 60.
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In a patient who has an optimal infratip lobule volume with a short columella and inadequate tip projection, augmentation of the tip projection by way of an onlay tip graft, a shield graft, or use of transdomal sutures will increase the infratip lobule volume and create additional imbalance between the nostril and infratip lobule.
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Means of elongation of the nostril length include insertion of a columella strut, approximation or reduction of the width of the footplates, application of an alar rim graft, elongation of the columella with suspension of the medial crura from the anterocaudal septum, and removal of a crescent-shaped piece of redundant soft triangle lining.
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Of the techniques available for the elongation of the nostril, removal of the soft triangle lining is the most potent one.
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Interdomal and transdomal sutures add to the lobule volume and also orient the nostrils more medially rendering them more vertical.
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Insertion of a columella strut will elongate the nostrils by stretching the soft tissues in the anterior direction, resulting in a medial orientation of the nostrils by virtue of placement of medial crura sutures to fix the columella strut, which is beneficial in most incidences.
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As the alar rim graft is inserted, not only does it correct the concavity of the ala, it also elongates the nostril.
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Patients who have large, deep facets and excessive infratip lobule volume would benefit from removal of the redundant soft triangle lining, which will elongate the nostril.
A congruous relationship between the nostril and the infratip lobule is crucial to nasal base harmony. Correction of the nostril size to bring it into equilibrium with the infratip lobule poses an additional challenge during the complex rhinoplasty procedure. The anatomical structures that contribute to the balance of the base of the nose include the nostrils, alar rim, soft triangle, medial crura, and footplates. These are easily assessed on the basilar view, although any disharmony in this area will be reflected on the front and profile views as well. A short or long nostril, or deficient or excessive infratip lobule, exists when the ratio between the infratip lobule and nostril, which is normally 40 : 60, is disturbed. A relationship of 45 : 55 is also acceptable ( Figure 13.1 ). A short nostril is generally the consequence of abnormalities in several areas. The components that contribute to short nostril include a short columella, redundant soft triangle lining, and weak and short ala. Alteration of any of these structures will contribute to elongation of the nostril proportionately.
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