ALAR BASE (NOSTRIL REDUCTION) RHINOPLASTY (Washington DC, Virginia & Chevy Chase Maryland)
Alar base reduction or nostril narrowing is one of the most over abused procedures in rhinoplasty. Too often rhinoplasty patients end up with unnecessary nostril reduction.
Alar base reduction is performed to narrow the skin portion of the nasal base. From the base view, the triangular nasal shape is made up of several anatomic components: anterior nasal spine, caudal septum, the 2 lower lateral cartilages and the skin of the nostrils.
If the nostrils are too wide then they may be reduced. There are 2 sections of the nostrils that need to be evaluated and possibly reduced. The alar side wall and the alar sil. One or both of these segments may need reduction. Alar base reduction is always the very last step of a rhinoplasty. After everything has been completed (bridge work, osteotomies, tip work, etc) then the nostrils and ala are evaluated again to see if they still look too wide or not. If not then they should be left alone to avoid the alar base reduction scars. If they still look too wide then very careful and precise alar base reduction should be performed meticulously. Complete symmetry is impossible to guarantee but the measurement and reduction of the two sides should be as symmetric as possible.
Some times alar reduction is all that is needed to create a nice and balanced nose if the other parts are just fine. Other times, alar base reduction can be used to correct asymmetric nostrils that were that way as result of previous rhinoplasty or just hereditary.
The worse case scenario is over aggressive alar base reduction resulting in vestibular stenosis and breathing obstruction. Correction of such bad complications of poorly performed nostril reduction involves the use of auricular composite grafts of skin and cartilage from the ears to open up the narrow nostrils. These are very complex cases where function takes precedence over aesthetics so its best to avoid creating bad nose job results like this.
Alar base reduction may also be necessary when the nostrils are notched or retracted either genetically or as result of previous rhinoplasty. Auricular composite grafts of skin and cartilage from the ears are placed inside the nostril to “push down” the notched or retracted ala and then alar reduction is performed to “pull in” the nostrils. This is a very complex maneuver and should be left to experienced Rhinoplasty Specialist Surgeons.