Quantitative Analysis of Tissue Excision and Alar Base Reduction in Combined Sill and Alar Excision

Background: Insufficient narrowing often occurs after alar base reduction due to inadequate tissue resection. This study quantitatively analyzes the relationship between excised tissue amount and postoperative narrowing in combined sill and alar excision. Methods: 268 Asian patients met inclusion criteria, including 12 males and 20 with prior alar base reduction. Pre- and postoperative anthropometric measurements were obtained using a vernier caliper. Changes in alar dimensions were compared, and correlations between tissue excision and narrowing were assessed. Outcomes were assessed via FACE-Q scales. Results: Mean external alar excision was 4.7 mm (0–7 mm) and internal sill excision 6.9 mm (4–9.5 mm). The average external alar flare width decreased significantly from 37.6 mm to 33.0 mm (P < 0.05), with concurrent reductions in internal flare width, alar base width, and nostril width (all P < 0.05). Internal sill excision was the dominant factor in alar base narrowing and strongly correlated with external flare reduction (r = 0.7). On average, 3.2 mm sill excision produced 1.0 mm external flare narrowing, with higher ratios required in smaller excision groups. Patient extreme dissatisfaction with nasal base width decreased from 66.1% to 4.3%, with significant improvement in FACE-Q nostril satisfaction scores (P < 0.05). Overall decision satisfaction was high (73.3 ± 19.7). Conclusion: Combined sill and alar excision effectively narrows the nasal base in Asians, achieving satisfactory aesthetic outcomes. These findings provide practical guidance for estimating tissue resection and predicting postoperative narrowing. Level of Evidence: 4