IDEAS AND INNOVATIONS
“The magic finger technique” a simplified approach
for more symmetric results in alar base resection
A. Emre Ilhan
Basak Caypinar Eser
Received: 27 June 2016 /Accepted: 21 August 2016 /Published online: 14 October 2016
Springer-Verlag Berlin Heidelberg 2016
Abstract Alar base surgery is one of the most important and
challenging steps of aesthetic rhinoplasty. While an ideally
shaped alar base is the goal in a desired nose, nearly all pa-
tients have asymmetric nostrils preoperatively.
Ethnicity, trauma, cocaine use, or previous rhinoplasties are
some factors affecting the width and shape of the nasal base.
After the conclusion of all planned rhinoplasty sequences
and closure of the mid-columellarincision, we mark the mid-
line inferior to the columella at the nasolabial junction and use
acaliper to measure an equal distance from the mid-columellar
point to the alar creases on eachside, and mark the medial
points of the alar creases. Next we draw on the natural
creasesbilaterally extending to 3 o’clock on the right side
and9o‘clock on the left side as the limit ofthe lateral excisions
to avoid scarring. We then gently depress the alae and alar-
facial grooveswith the index finger and allow the formation of
new creases superior to the original alarcreases in order to
detect excess skin to remove. After marking, the resection
was performed with a no. 15 blade. The excision was closed
using 6-0 Prolene sutures.
We aimed to describe a simple technique for making asym-
metric resections in which theapplication of pressure by a
finger reveals excess skin in both nostril sill and nostril
flareindependently for each alar base. With these asymmetric
excisions from the right and left alar bases, a more symmetric
nostrils and nasal base can be achieved.
Level of Evidence: Level IV, therapeutic study.
Keywords Alar base
Alar base surgery is one of the most important and challenging
steps of esthetic rhinoplasty. While an ideally shaped alar base
is the goal in a desired nose, nearly all patients have asymmet-
ric nostrils preoperatively.
“Alar base” refers to the bottom third of the nose
when the head is tilted back . It is generally accepted
that reduction of the nasal base width should be consid-
ered when interalar distance exceeds intercanthal dis-
tance in the Caucasian patient [2–7], and ethnic varia-
tions in alar base anatomy have been described [8–9].
Ethnicity, trauma, cocaine use, or previous rhinoplasties
are some factors affecting the width and shape of the
nasal base [10, 11].
Surgery through the alar base aims to avoid
overstraightening the ala, to preserve the natural curvature of
the ala, to avoid apparent incisions into the nostril opening,
and to have a more symmetric appearance between the
Although the concept of nasal base narrowing was
introduced over a century ago and numerous techniques
and various modifications have been devised for alar
base remodeling, it continues to be controversial and
sometimes confusing for the rhinoplasty surgeon.
Basically, the most challenging aspect of intervention
through the alar base is creating more symmetry in the
sizes and shapes of the nostrils, as they are frequently
Preoperative evaluation is critical and should include the size,
shape, and symmetry of the nostrils; the width and position of
the columella; the relationship between columellar length and
* Basak Caypinar Eser
ENT Clinic, Rino Center, Istanbul, Turkey
Eur J Plast Surg (2017) 40:137–142