Nasal Base

Abstract

The nasal base is the least understood area of the nose. Surgical errors of omission lead to less than optimal results while errors of commission can produce irreparable deformities. Perhaps, there is a perception that these are “ancillary techniques” rather than an integral part of a rhinoplasty. Or perhaps not enough time is taken to study the aesthetic and anatomical subtleties of the area. Unfortunately, analysis can be complex and the etiology of a problem multifactorial. For example, the nostril on lateral view must be evaluated as an alar rim/nostril/columella complex before an etiology of alar retraction or hanging columella is assigned. The alar rim on lateral view is analyzed according to its inclination, location of breakpoint, relative lengths, and downward angulation. Another problem is that the nasal base is not a distinct anatomical entity. The impact of adjacent structures is a critical consideration. The most obvious is the impact of the caudal septum on the columella, which can result in deviation, retraction, or a hanging deformity. Despite the analytical complexity, most of the surgical solutions are straightforward once the correct diagnosis is made. The procedures must be done meticulously or permanent deformities can occur. Although challenging, it is my belief that a properly planned and executed alar base modification can have as great an impact on a rhinoplasty result as a tip graft. Thus, the surgeon should integrate modification of the nasal base into the operative plan based on careful preoperative analysis and meticulous intraoperative execution.