The nose occupies a central position on the face, making it a defining characteristic of facial aesthetics and balance. The ala is the fleshy, curved lower part that forms the outer wall of the nostril opening. The alar base is where the ala meets the cheek and upper lip. Variations in the size or width of the alar base can affect facial harmony, leading some individuals to seek cosmetic alteration to balance facial features.
Defining Alar Reduction
Alar reduction, also called alarplasty or nasal base reduction, is a cosmetic surgical procedure designed to narrow the width of the nostrils or reduce alar flare (outward curve). The procedure corrects a disproportionately wide nasal base to achieve a more refined and symmetrical appearance. Aesthetic guidelines suggest the ideal nasal base width should not extend past the vertical lines drawn from the inner corners of the eyes (intercanthal distance). Unlike a full rhinoplasty, which alters the nasal bridge or cartilage, alar reduction focuses exclusively on the soft tissue at the base of the nose. It can be performed as a standalone operation or as a complementary maneuver during comprehensive nose surgery.
The Surgical Procedure
The procedure is generally performed on an outpatient basis, utilizing local anesthesia combined with light sedation. The surgeon meticulously marks the planned excision areas to ensure symmetry and the desired degree of narrowing. Incisions must be placed strategically to conceal the resulting scars within the natural creases of the nose.
Two principal techniques are used, often combined, depending on the patient’s anatomy and goals. The alar wedge excision (Weir excision) reduces excessive alar flare by removing a wedge-shaped segment of tissue where the ala meets the cheek. This reduces the outward projection of the nostril rim, narrowing the nasal base. The nasal sill excision is used when the floor of the nostril (the sill) is too wide. A segment of tissue is removed from the horizontal floor, narrowing the distance between the two alar bases. Once the tissue is removed, the remaining skin edges are carefully sutured together using fine stitches. These sutures bring the nostril walls closer, reducing the overall width of the base.
Recovery and Post-Operative Care
Following the procedure, patients can expect immediate swelling, redness, and minor bruising around the surgical sites. Discomfort is typically managed with over-the-counter or prescribed pain medication. For the first few days, applying cold compresses and keeping the head elevated helps minimize initial swelling.
The sutures are typically removed within five to seven days after the operation. Patients should keep incision sites clean and may use scar management products to promote optimal healing. Most patients return to work and social activities within one to two weeks as noticeable swelling subsides. Strenuous physical activities and actions that cause excessive nostril movement, such as forceful nose blowing, must be avoided for several weeks. While initial recovery is quick, final results appear gradually as residual swelling dissipates over six months to a full year.
Candidacy and Important Considerations
Individuals who are generally in good health and have specific concerns about wide alar bases or excessive nostril flare are candidates for this procedure. Nasal anatomy is evaluated in relation to the entire face, especially for those whose alar width is notably wider than the distance between their inner eye corners. Patients must maintain realistic expectations, understanding the goal is aesthetic improvement, not absolute perfection.
A surgeon must carefully maintain the natural curvature of the ala and ensure that the narrowing is proportional and respects the patient’s ethnic identity. Excessive reduction (over-reduction) can lead to an unnatural, pinched appearance or negatively affect nasal breathing. Potential risks include visible scarring, asymmetry, infection, or poor wound healing. Consulting with a board-certified plastic surgeon experienced in nasal base modification is the best way to mitigate these risks and achieve a satisfying result.