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The relationship of the alar rim to columella visibility and nostril proportion is crucial to a good aesthetic result. The alar rim has been a neglected part of the nose in primary and secondary rhinoplasty procedures for want of a natural contouring operation. Results of directly excising the alar rim and its indications are presented with adequate follow-up. Indications for the procedure include (1) recontouring of the cleft lip nose with anterior webbing, (2) equalizing asymmetrical nostrils, (3) enlarging small nostrils, (4) correcting a hanging (sigmoid) ala, and (5) converting round to oval nostrils.
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Ellenbogen et al. (1992) studied this question.
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