This article explains the way to treat vertical alar discrepancy through alar crease and alar sulcus full-thickness incisions and advancement-rotation of the alar flaps. The authors divide the group of patients into three main categories depending on the vertical movement required: unilateral cephalic, unilateral caudal or bilateral combined. The caudal movement of the ala requires a de-epithelisation of the skin of the upper lip where the ala is intended to be re-attached. The cranial movement of the ala needs the resection of an oval of supra-alar skin that can be used as a skin graft to cover the defect in the upper lip skin created by the upward movement of the alar flap. Fifteen of the 24 patients of the study group had previously had cleft-lip palate procedures and the rest had this problem as a result of previous surgery or nasal trauma. The complication rate was low and only two patients needed revision surgery due to a visible scar in one of them and surgical hypercorrection in the other. Vertical alar asymmetry is a very difficult problem to treat, especially in cleft-lip palate patients, in whom the discrepancy is sometimes too big to only be treated by traditional alar base procedures; the seesaw technique is a simple and safe technique to deal with this complex problem. The only drawback of the operation is that it leaves an external scar along the alar crease that may be difficult to conceal and that full-thickness incisions through both alar crease and alar sulcus may risk vascular necrosis of the whole nasal ala if an inadequate pedicle is left. This is a very interesting paper for rhinoplasty surgeons, especially for those with cleft-lip palate practice.

The seesaw technique for correction of vertical alar discrepancy.
Hyun SM, Medikeri GS, Jung DH.
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Eduardo Morera Serna

Hospital Universitario Son Espases, Palma de Mallorca, Spain.

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