Nasal Base

Abstract

The nasal base is probably the least understood and most complex area of the nose. Surgical errors of omission lead to less than optimal results, while errors of commission can produce irreparable deformities. Errors occur because surgeons assume 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. Anatomically, the nasal base is not a distinct anatomical entity. The impact of adjacent structures is of critical importance. One must always assess the influence 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 procedure must be done meticulously or permanent deformities can occur. Although challenging, it is my belief that a properly planned and executed alar base modi-fication can have as great an impact on a rhinoplasty result as a tip graft.