bowling pin deformity is a deformity of nose if the alar are corrected

alar reconstruction

1. Bowling pin deformity Dr Madhuri reddy

2. The anatomic constituents of the alar base are the infratip lobule superiorly, the nasal alae laterally, the columella centrally, and the nasal sills inferiorly, bounded by the junction of the alae and the columella with the upper lip. From the basal view, the area should resemble an equilateral triangle, with a columella-to-lobule length ratio of 2:1.

3. Sheen and Sheen described the alar axis with analysis of the relationship between the vertical plane of the alar lobule to the horizontal plane of the nasal base. When seen from the frontal view, the orientation of the alae can be categorized as divergent (flared), straight, or convergent (acute) . They believed extreme lateral divergence would benefit from medial repositioning of the nostril, whereas perpendicular or acute nostrils were poor candidates for alar resections, resulting in a pinched or “bowling pin” look.

4. If the nasal vault is wide then the alae must be wide. Otherwise, you will create the deformity. On the left you will see a wide alae that is correctable by an alar excision. This is because the alae abruptly flare out compared to the middle portion of the nose. Compare this to the image on the right. This wide alae is not correctable. This is because the alae does not flare out abruptly. This alae flares out gradually starting farther up the nose.

5. Thank you.

6. References Rohrich RJ, Savetsky IL, Suszynski TM, Mohan R, Avashia YJ. Systematic Surgical Approach to Alar Base Surgery in Rhinoplasty. Plast Reconstr Surg. 2020 Dec;146(6):1259-1267. doi : 10.1097/PRS.0000000000007385. PMID: 33234955. https:// plasticsurgerykey.com /managing-alar-base-complications/ https:// orangecountycosmeticsurgery.com /rhinoplasty-5-nostril-narrowing/