The arrow tip technique for bilateral hanging ala: a 3-year review

Hanging ala is one of the alar-columellar discrepancies encountered in a rhinoplasty procedure among the Asian population. The principle of lifting both the ala effectively while keeping its symmetry remains a challenge. The arrow tip technique is designed to address the bilateral hanging ala which allows greater alar mobility and lifting effect, producing a desirable outcome of the overall nasal feature. This retrospective review is aimed to analyse the effectiveness of the proposed alar surgical technique and assesses the possible complications that require revision surgery. Fifteen Asian patients underwent the ‘arrow tip technique’ alar surgery in conjunction of a rhinoplasty procedure in a single-centre 3-year study for bilateral hanging ala. Pre- and post-operative clinical and photographic nasal analyses were performed for changes of alar vertical height on lateral and frontal views. On the frontal view, the mean percentage of alar shortening was 13.11%, 95%CI [11.46%, 14.76%]. On the lateral view, the mean percentage of alar shortening was 20.36%, 95%CI [19.01%, 21.71%]. The mean frontal-lateral alar shortening was − 7.25%, 95%CI [− 8.76%, − 5.74%]. Two patients required revision surgery for scars (13.3%) and another for nostril asymmetry (6%). This innovative technique is effective, safe and predictable in correcting the hanging ala. Understanding the relevance of performing an effective alar surgery through safe surgical landmarks, the use of full-thickness skin grafts and taking proper precautions can avoid the unnecessary fear of the complications of an external approach to an alar surgery such as scarring, bleeding, alar asymmetry and recurrence.

Level of evidence: Level IV, therapeutic study.