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PROFILES Modern Rhinoplasty Textbook

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Alar Base Reduction

Written by Dr. Litner and Dr. Solieman

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.

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.

Male face Before Septal Perforation treatment, front viewMale face After Septal Perforation treatment, front viewBeforeAfter
Male face Before Septal Perforation treatment, right side viewMale face After Septal Perforation treatment, right side viewBeforeAfter

Surgical Techniques

In alar base reduction procedures, two techniques are widely used.

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 goal of an alar reduction procedure is to achieve natural, well-proportioned results with no secondary distortion.


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