Nasal Base Modification

The Problem

The nasal base is an important aspect of the nose that frequently needs to be changed in aesthetic nose surgery. Wide nasal bases that are exacerbated by facial movements are the subject of this chapter.

The Background

There are numerous techniques to modify and reduce the nasal base. The main goal of most of these techniques is to find the best way to remove some nasal tissue in a way that has the best effect on nasal base dimensions and leaves minimal visible scars. Although these techniques have been successfully used for a long time, excessive resections may end up in severe scarring or a recurrence of the initial problem. Additionally, wide nasal base resections may lead to nostril distortion and/or nasal breathing difficulties.

Preservation and manipulation of nasal ligaments is an emerging concept in rhinoplasty. Pyriform ligaments are wide bands of fibrous tissue that originate from the pyriform aperture and encompass the sesamoid, upper lateral, and lower lateral cartilages. Some authors believe that pyriform ligament release and medialization of the alar wall is a more effective method to address a wide nasal base in indicated cases.

The Indications

The clear indications for nasal base modification with pyriform ligament release may be summarized with some major indications:

• 1.

  Wide nasal bases in which the surgeon wants to avoid excessive resections.

• 2.

  Hyperanimated wide nasal bases that get worse when smiling and speaking.

• 3.

  Failure of previous alar base resection with severe scar contraction (tear drop deformity).

• 4.

  Management of alar flaring resulting from alar rim grafts.

• 5.

  Avoidance of very convergent appearance.