Abstract
South East Asian noses have a characteristic ala and columella disproportion and mostly
manifest as hanging ala. Simultaneous correction during rhinoplasty is recommended
to achieve a good aesthetic result. Since hanging ala is a common feature, a classification
system is presented as a guide for surgical management. The classification is based
on the frontal view showing the alar rim connecting to the columella lobule area simulating
the wings of a gull in gentle flight. A mild deformity has the gull's wing in the
horizontal direction. A moderate deformity has the gull's wing in a slight inferior
direction. A severe hanging deformity has the gull's wing in the inferior direction,
ending below the columella lobule area, and this is mostly accompanied by retracted
columella. There are various techniques for the surgical correction of hanging ala.
The author has made a modification of the internal approach called “sail excision”
using the groove within the lateral nasal vestibule as a landmark. The author terms
this area as the vestibular groove. Sail excision involves removal of a triangular portion of tissue anterior to this
vestibular groove. Another aesthetic deformity noticed in South East Asian noses is
that the alar rim base is lower than the columellar base. In correcting hanging ala
with involvement of the alar rim base, the sail excision is extended posteriorly following
the vestibular groove as its guide to the amount to be excised. To enhance the overall
aesthetic outcome, the acute columella labial angle seen in South East Asian noses
has to be made fuller through surgery. This is accomplished using septal extension
graft for tip projection, with preservation of the posterior angle of the caudal septum.
Plumping grafts are used as filler material in the premaxillary area.
Keywords
South East Asian nose - hanging ala - vestibular groove - sail excision - extended
sail excision
