X Suture Technique for Alar Base Contouring and Nostril Symmetry in Rhinoplasty

Alar base surgery plays a critical role in achieving both aesthetic harmony and functional integrity in rhinoplasty. Despite appropriate alar base resection, residual asymmetry and undesired nostril shape variations may persist, particularly in patients with intrinsic facial asymmetry or prior surgery. In this study, we describe a novel X suture technique designed to refine alar base contour and optimize nostril shape. This clinical observational study included 32 patients (18 primary and 14 revision rhinoplasty cases) with varying degrees of nostril asymmetry or shape irregularities. All procedures were performed using an open structural rhinoplasty approach, followed by standardized alar base resection. The X suture technique was applied to modulate nostril roundness and improve symmetry by adjusting the alar-facial junction. Postoperative outcomes demonstrated satisfactory aesthetic results in the majority of patients. One patient developed early suture dehiscence requiring revision, and one patient underwent delayed suture adjustment under local anesthesia. No major complications were observed. The technique allowed controlled modification of nostril contour, enabling both reduction and enhancement of roundness according to individual anatomic and ethnic considerations. The X suture technique provides a simple, reproducible, and effective method for fine-tuning alar base contour and nostril symmetry. It is particularly useful in cases where resection alone is insufficient to achieve optimal results. This approach may expand the surgical armamentarium for managing nostril asymmetry and improving postoperative aesthetic outcomes in rhinoplasty.