Facial Plast Surg 2023; 39(06): 668-673
DOI: 10.1055/a-2127-3665
Original Article

Rhinoplasty in Patients with Cleft Lip Nasal Deformity: Correcting the Alar Base

1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California Davis, Sacramento, California
,
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California Davis, Sacramento, California
› Author Affiliations

Abstract

The characteristic cleft nasal deformity presents several challenges for the rhinoplasty surgeon attempting to provide the optimal nasal function and appearance for their patient. One of the difficulties with cleft rhinoplasty is how best to address the malposition alar base. The purpose of this review is to evaluate the various surgical approaches and techniques for properly repositioning the alar base for cleft patients. Outcomes are ultimately dependent on individual patient factors, anatomy, surgical technique, and surgeon experience. Below, we will review the variety of techniques used, the evidence supporting certain techniques, and our preferences.



Publication History

Accepted Manuscript online:
11 July 2023

Article published online:
08 August 2023

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