Hunstad Kortesis Bharti Cosmetic Surgery

Alar base reduction is a procedure of balance between multiple structures of the lower nasal vault. This study aimed to describe the alar cinch suture nasal sill excision combination technique and to present our consecutive patient series. The cinch suture nasal sill excision combination technique is described in a step-by-step fashion and illustrated by pre-, post-, and intra-operative photographs, as well as videos. A study of consecutive patients presenting for primary rhinoplasty who required bilateral alar base reduction from October 2016 to October 2019 was performed. A total of 21 patients with a minimum of 12 months post-operative follow-up were included in the study. There were no major or minor complications. The technique involves dynamic manipulation of the nasal base structures and is highly applicable to every alar axis. The cinch suture nasal sill excision combination technique is a simple and durable technique for alar base reduction. It provides predictable outcomes while allowing for control of the lower nasal vault structures. Level of evidence: LeveI IV, therapeutic study.

Sir: We thank the authors for their reply to our thighplasty article.1 We appreciate their comments and applaud their interest in minimizing lymphatic disruption during these procedures. They noted correctly that this technique was adapted from our previously published experience with brachioplasty.2 We were very interested in their described technical variations from our article. We agree that liposuction is instrumental in preserving lymphatics and neurovascular structures. We are interested in their sharp subdermal dissection of skin versus our avulsion method. We understand their desire to sharply cut the distal channels to preserve a maximum amount of these delicate tissues. This achieves a similar goal of avulsion, provided that the skin is avulsed in a gentle and controlled fashion, with a proximal hand holding the lymphatic structures in place while force is applied with the distal hand. We believe this technique also severs only the smallest of subdermal channels, provided that it is done gently and after a very thorough and aggressive liposuction beneath the entire planned resection. We find the speed and efficiency of skin removal the most appealing characteristics of the avulsion technique. Ensuring proper tension before skin incision is critical to avoid the most dreaded complication of inability to close with either brachioplasty or thigh lift. Their use of staples to “tailor tack” the skin and to simulate final tension appears very effective. We agree with their recommendation that by performing this bilaterally the surgeon can assess the final aesthetic outcome. We will certainly take that under advisement, particularly in the proximal thigh, where we have had to perform some revisions for excess tissue after avulsion thighplasty. We thank them again for their kind comments, and we are very pleased that other authors are finding liposuction-assisted methodologies for brachioplasty and thigh lifting useful and advisable.3 DISCLOSURE Neither of the authors has a financial interest to declare in relation to the content of this communication. Joseph P. Hunstad, M.D.Hunstad-Kortesis Center for Cosmetic SurgeryHuntersville, N.C.University of North Carolina at Chapel HillChapel Hill, N.C. Christopher D. Knotts, M.D.Austin-Weston Center for Cosmetic SurgeryReston, Va.