Alaplasty can be done as a solitary procedure

Alaplasty can be done as a solitary procedure, but in my experience, there are very few patients for whom that is appropriate. Most patients who have wide nostril floors (the usual and best reason to alter the ala) have other imperfections that need attention.

Most often, if the other changes are made, particularly narrowing the tip, there is some narrowing of the top of the ala such that there is less need for a separate procedure to be performed on them.

Best advice: Have computer imaging to show you the predicted result of just the alar narrowing, and another to show you what other changes can be made without narrowing, and yet another showing both the general rhinoplasty changes + the alar narrowing. Then, you can make a more informed incision.

And, finally, " When in doubt, do without"!

 You don't have to do the whole nose if only the base bothers you. Remember though, when you do this you will make the rest of the nose appear wider.

Improving the size or shape of the nostrils can be done alone. However, it is rare that a person's nose will only need the nostrils changed without needing a change in the other areas.

The nose is a complex 3D structure. Sometimes changes in one area will need changes in the other areas to maintain balance and harmony. It is possible that reducing only the alar area will make the tip of the nose appear larger.

Make sure to have a careful discussion about this with your surgeon. Don't be afraid of undergoing a full rhinoplasty if you need to. It is better to have it done correctly once the first time around. You will really regret it later if you have to go back under surgery to make other changes.

They are many different types of alar rims, skin types, nostril thicknesses, lumens, etc. and each requires a different surgery. It may be necessary to narrow the nostril sill, the ala itself, the alar height, the alar positioning etc.

As many of my colleagues have also pointed out, everything you do to the nose affects everything else, not only the appearance but also the breathing.

Your best best is to consult a board certified plastic surgeon with considerable experience in nasal surgery to get your best result.

Certainly almost any surgery can be done under local anesthesia; the patient's medical history, pain tolerance and anxiety level will determine which anesthetic is best for the patient.