Correction of Prominent Alar Lobule by Resecting Dilator Naris Muscles: A Pilot Study

Shin, Soo Hye; Park, Hyun; Han, Seung Kyu; Kim, Woo Kyung

Abstract

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+/-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+/-0.11 and postoperatively 0.58+/-0.08; p<0.05). The VAS score was also increased postoperatively(preoperatively 3.2+/-1.8 and postoperatively 8.7+/-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.