Alar Base Reduction
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The nasal ala (literally meaning the “wing” of the nose) is the anatomical term used to describe the flaring, rounded outer part of the nose, which we usually call the nostrils. Composed of cartilage at the upper nostril crease and soft tissue down to the nostril rim, this flexible wall forms the lateral, or side, boundary of the nose.
The alar base refers to the base of the nostrils where they join the cheek and upper lip areas. The width, shape, and overall proportions of this area are a common cosmetic concern. A typical complaint from those seeking rhinoplasty is that their nostrils are “too wide.” In fact, a wide or flaring alar base is a naturally-occurring feature that is characteristic of many individuals and particularly prevalent in individuals of African-American and Southeast Asian descent. For those who would like to bring prominent, wide or rounded nostrils into greater balance with the rest of their face, an alar base reduction, or nostril narrowing, procedure is an ideal option.
Evaluation and Treatment
Because of individual variability and the complexity of the alar base structure, alar base surgery poses a unique set of challenges. During a surgical evaluation, the alar base will be evaluated in terms nostril size, shape and symmetry and how the alar base structure relates to the rest of the face. Other factors will be assessed and noted, such as of the thickness of the skin.
Drs. Solieman and Litner consider alar base reductions in the context of an overall surgical plan. It is important to note that no surgeon can fully determine the exact location, shape, and amount of alar base alteration which is required before surgery. Because the nostril size and shape, as well as alar base width and flare, are all affected by other changes made during rhinoplasty, the final and appropriate surgical decision and aesthetic judgment call will be made during the finishing stages of the actual procedure.
In alar base reduction procedures, two techniques are widely used.
- Weir Incisions. One of the most popular surgical techniques for alar base reduction, the Weir technique involves the removal of a small wedge of tissue from the edge of the nostril, at the point where the nostril meets the cheek. The nostril is then pulled down and reattached. This procedure is typically used to remove nostril flare or rounding of the nostrils.
- Joseph Incisions. Another common technique, Joseph incisions involve the removal of tissue at the base of the nose, in an area called the nasal sill. The nasal sill is the shelf-like portion of skin in between the nostril edge and columella that separates the nostril from the upper lip. The edges of skin are then pulled together to narrow the opening. This procedure is best for reducing overall nostril width.
After an alar base reduction, the ala should still be rounded. If an alar base reduction is done incorrectly or the removal of tissue is over-aggressive, a patient can lose the natural curve to the nostril and be left with an overly pinched, triangular appearance in the nostril area and/or scars and abnormal notching.
To prevent this outcome, Drs. Solieman and Litner have developed specific surgical techniques in order to maximize the chances for a smooth, natural nostril contour with no discernible scar. During an alar base reduction procedure, Drs. Solieman and Litner first remove a crescent-shaped wedge of skin from the nasal sill, and then make careful incision just above the crease of the nostril. This allows optimal correction of both nostril width and flare through one incision. By using this combination surgical technique, Drs. Solieman and Litner can individually tailor the surgery to the specific anatomy of the patient. As a result, they have greater control of the outcome. Some additional benefits include:
- The preservation of the natural nostril curve
- Inconspicuous, well-concealed scars that tend to heal more quickly
- The natural crease between the nostrils and cheeks is maintained
- Improvement of the internal shape of the nostril
The goal of an alar reduction procedure is to achieve natural, well-proportioned results with no secondary distortion.