Did My Alar Cinch Suture Work?

Q: Dr. Eppley, I had an alar cinch suture to reduce nostril flare and widening. What is the recovery like from a alar cinch suture. I had one a week ago and see no change. Nostrils actually look wider, should I expect it to look worse before it looks better? The surgeon overcorrected but it doesn’t look that way. Face is very stiff and upper lip doesn’t move, laughing is very painful. The stitch  will absorb in 3-4 months. Can this all just be swelling? Does it need to be a permanant suture to have lasting effect?

A: You did not say exactly why you had an alar cinch suture. Was it as part of a maxillary osteotomy or rhinoplasty procedure? And what was its purpose?

The reason that I ask these questions is because an alar cinch suture is really a preventative nasal base maneuver rather than a treatment for nostril narrowing in most cases. If the purpose was to actually narrow the nasal base/nostril width, I would not expect it to be particularly effective. By pinching the alar bases together by suturing, a whole host of symptoms result from so doing as you have described. Stiffness and negative effects on upper lip movement will result. While the swelling and these symptoms will resolve with time as the suture relaxes/absorbs, I would not expect any nostril narrowing (even if it was created) to be sustained. Certainly a permanent suture is not going to be the answer.
If the goal was to narrow the nostril base for wide or flaring nostrils, there are much more effective and less arduous procedures to do. Alar base resection is more effective, easier to go through and permanent. Careful placement of the incisions in or around the nostrils can result in a low risk of any adverse scarring.

Dr. Barry Eppley
Indianapolis, Indiana