(a) Alar retraction secondary to multiple tumor extirpations resulting in an ecnasion. (b) A Z-plasty is planned. One relatively simple way to estimate the angles is to draw out the peripheral arms at 90 angles to the central limb and then divide this in 1/2 to get 45-degree angles or trisect it to obtain 30- or 60-degree angles as shown. (c) Z-plasty sutured in place. ((d) and (e)) Frontal and lateral views demonstrating that alar retraction has improved but not completely resolved (cf. Figure 5(a)). (f) Another, more inferior Z-plasty is planned at a later date. (g) A strip of cartilage is used underneath the flap to provide structural support to the alar rim. (h) Z-plasty sutured in place. (i) Patient at suture removal. (j-k) Frontal and lateral views demonstrating resolution of the ecnasion.
