Correction of Prominent Alar Lobule by Resecting Dilator Naris Muscles: A Pilot Study

PURPOSE: The authors have conducted a series of anatomic studies on the factors affecting shape of a lower vault in Asian noses. The results of the studies showed that prominence of alar lobule is mainly affected by the volumes of the dilator naris anterior and posterior muscles and the insertions of the dilator naris posterior muscles. However, information on its clinical availability is yet insufficient. The present study was undertaken for clinical purpose to find out the effect of dilator naris muscle resection on the correction of prominent alar lobule. METHODS: Six patients who were treated by dilator naris muscle resection with a long-term follow-up of more than 1 year were involved in this study. Rhinoplasties were performed via endonasal approaches with resecting dilator naris anterior and posterior muscles by sharp scissor. The effect of the dilator naris muscle resection on alar prominence was investigated by measuring ratio of the short axis to the long axis of a nostril(SA/LA) pre-and postoperatively. The visual analog scale(VAS) was also used to evaluate satisfaction of patients. An average follow-up time was 15.6+/-3.7 months. RESULTS: Having lost the dilating and lateral pulling effects of the dilator naris muscles, the alar lobule shifted medially and alar lobule shapes improved. SA/LA significantly improved(preoperatively 0.71+/-0.11 and postoperatively 0.58+/-0.08; p<0.05). The VAS score was also increased postoperatively(preoperatively 3.2+/-1.8 and postoperatively 8.7+/-1.2; p<0.05). A mild degree of hyperpigmented scar was noted in one alar lobule. Otherwise, there was no case of postoperative complication. CONCLUSION: Our results suggest that prominent alar lobule could be modified by resecting the attachment of the dilator naris muscles. This maneuver removes the function of dilator naris muscles, then may produce a more aesthetically acceptable alar lobule shape.

The Efficacy of New Hyaluronic Acid Filler (HyaFilia)

PURPOSE: Currently, soft tissue filler products based on hyaluronic acid are widely used. They are safe, effective, and convenient to use compared with bovine collagens. However, all commercially available hyaluronic acid based fillers in Korea are imported ones. The purpose of this study is to evaluate efficacy of a new hyaluronic acid filler (HyaFilia; CHA bio&Diostech Co., Seoul), which has been recently developed in Korea. METHODS: Three kinds of soft tissue fillers, including Restylane(Q-Med, Uppsala, Sweden), HyaFilia(CHA bio & Diostech Co., Seoul), Juvederm(Allergan, CA, USA), were injected subdermally into the back of hairless mice at six sites. The 2 cephalic sites composed Restylane groups, the 2 middle sites HyaFilia groups, and the 2 caudal sites Juvederm groups. Six hairless mice were included in the study, therefore, a total of 12 injections per group were performed. After 16 weeks after injection, the nodular swellings that resulted from the injections were excised wide enough to include skin beyond the swelling points down to the panniculus carnosus layer using 8mm punches. Volumes and weights were measured using a stereoimage optical topometer system and a weighting machine. Histologic comparisons were also carried out. RESULTS: The mean volumes of the Restylane, HyaFilia and Juvederm groups were 3698 x 103, 4820 x 103, and 1435 x 103 PI, respectively. The mean weights of the Restylane, HyaFilia and Juvederm groups were 36.08, 37.83, and 24.66mg, respectively. Histologic examination between the 3 groups showed no significant difference in tissue compositions and inflammatory reactions. CONCLUSION: The results of this study shows that HyaFilia is superior to Restylane and Juvederm in longavity of filling effect. Therefore, HyaFilia may be an effective replacement for the imported materials including Restylane and Juvederm.