Investigating the Effect of Bilateral Facial Repositioning Using a Mattress Suture to Correct a Very Wide Alar Base in Rhinoplasty

Background: In recent years, the prevalence of various rhinoplasty procedures has increased.Alar base reduction (ABR) techniques are utilized in approximately 15-20% of these patients.Major studies indicate that under correction of alar base is a primary cause of patient dissatisfaction and suboptimal outcomes.We aimed to compare conventional bilateral ABR with a modified technique involving bilateral facial repositioning (bilateral facial medial advancement) using a mattress suture (BFR-mattress).Methods: Forty-two septorhinoplasty candidates requiring ABR were enrolled into two groups: a control group (conventional bilateral ABR) and an intervention group (ABR with BFR-mattress).Standardized photographic documentation was obtained preoperatively and at the 6-month followup.Outcomes were assessed based on patient-reported satisfaction and evaluations by blinded independent surgeon.Results: No significant differences were found between the groups in demographic parameters (age, sex distribution; P > 0.05).Preoperative interalar-to-intercanthal ratios were comparable between the groups (Control: 1.21 ± 0.12, Intervention: 1.20 ± 0.06; P = 0.885).At 6 months, the intervention group exhibited significantly lower ratios (1.13 ± 0.09 [in control group] vs. 1.04 ± 0.07 [in intervention group]; P = 0.003), indicating more narrowing of the alar base.Notably, despite achieving greater alar base reduction, the BFR-mattress technique resulted in comparable outcomes in nasal obstruction, symmetry and scar appearance. Conclusion:The BFR-mattress suture technique provides significantly greater alar base width reduction compared to conventional ABR, without increasing complication rates.