Reconstruction of the Alar-Facial Groove Using a Nasolabial Flap and Medial Directional Force with a 'Tissue-Adding' Effect.

Reconstructing the nose, especially the alar-facial groove, is difficult because of its 3-dimensional structural characteristics. We report the case of a 33-year-old man with a history of crush injury to the nose 15 years previously. We performed reconstruction because of scar contracture formation in the left alar-facial groove (Fig. 1).

Fig. 1.

Preoperative view showing the vague alar-facial groove resulting from a crush injury.

This study was reviewed and approved by the Ethics Review Board of the Inje University Health Center.

A V-Y advancement flap was designed by setting the nasolabial fold as the superior margin and the elevated alar-facial groove as the medial margin. A cutaneous perforator flap was then elevated [1]. The scar tissue in the alar-facial groove, including the skin and subcutaneous layer, was minimally excised, by 1.0×0.2 cm (Fig. 2).

Fig. 2.

Illustration of the surgical technique. Scar tissue on the alar-facial groove was resected with a minimal incision and elevated in the nasolabial fold direction with a V-Y flap design. Point A moved to A’, and point B moved to B’ by the V-Y advancement flap.

The septum was peeled back to expose the anterior nasal spine, and the bottom surface of the alar side was fixed to a firm area near the anterior nasal spine. This can be done via open rhinoplasty or a minimal incision in the mucosa inside the nostril (Fig. 3).

Fig. 3.

Fixation of the alar base, close to the hard area of the anterior nasal spine, where it forms a reentrant alar-facial groove. The location of fixation should be decided based on the symmetry of both sides of the nasal cavity. If only reconstruction of the alar-facial groove is planned, a minimal incision can be made in the mucosa inside the nostril. The yellow (C) area corresponds to excised scar tissue. ANS, anterior nasal spine.

The alar-side surface of the area from which the scar tissue was excised and the medial area of the nasolabial V-Y flap were sutured together. In this manner, a stronger and more prominent secondary alar-facial groove was constructed (Fig. 4).

Fig. 4.

Postoperative view flap 5 months after surgery showing the formation of the reentrant area on the initially vague alar-facial groove and minimal scarring caused by the V-Y advancement.

The definitive treatment for patients needing alar-facial groove reconstruction has not been established. The skirt flap is not optimal for a prominent alar-facial groove [2], nor is the feather-edge rolled-in flap optimal for resolving the tension around the groove [3]. We used a nasolabial flap and ‘tissue-adding’ to reconstruct the alar-facial groove. This technique reduces tension and yields more prominent results by providing a force in the medial direction.