Is 2 mm in alar reduction more noticeable in thin nostrils? (Photo)

Question

I am curious if 2 mm of sill and wedge will make a good difference in individuals who just want the alar reduced. Will this significantly make the tip look bigger in illusion for those who have a slight wide tip or will it be a conservative amount for someone who just wants to bring in the nostrils.

Donald B. Yoo, MD, FACS · Answer

The nose pictured is a good candidate for alarplasty with combined nasal sill and Weir incisions. The proportions of the nostril width and tip width is important for the surgeon to consider when designing the incisions.

Eric M. Joseph, MD · Answer

I believe it is true that nostril narrowing alone can lead to a wider nasal tip appearance. That said, your solo photo does not appear to show a very wide nasal tip appearance. It's also difficult to assess your candidacy from alarplasty with that single photo. Thanks so much for this question and I hope it's helpful. Sincerely, Dr Joseph

Tanveer Janjua, MD · Answer

Alarplasty is a very fine and quick procedure that can narrow the nostrils and reduce the flare to soften the appearance. It has other names as well like ‘Weir Excisions’ or ‘Nostril Reduction’. It can be done under local anesthesia. The social down time is about a week. If you want to work from home you can start it the next day. For the procedure you are evaluated to determine how much of a change is needed. In the past surgeons had recommended 2mm to 5mm reduction. This was measured by drawing a vertical line at the lateral sides of the nostrils (alae). However, I prefer to use a mirror and Q-tips to show the patient how much of a change can be accomplished. Pushing with Q-tips from the sides can mimic the change. Patient can also pinch their upper lip near the base of the nose and will show them how much narrowing to expect. I try to quantify the change as small, medium and large. Rarely it can be extra large as well. I always advise the patients to be conservative in the change as it is an irreversible procedure. The procedure historically did not get a lot of attention in plastic surgery. It was always thought of an adjunct procedure done with a rhinoplasty. Historically most ethnic groups did not get rhinoplasties. Hence, the caucasian rhinoplasty was the main procedure that plastic surgeons were trained on. 15 years ago I started making videos on the procedure and putting them on YouTube. In my blogs I started using the term 'Alarplasty' as most doctors and patients were using the term nostril reduction or Weir Excisions. I started noticing that over years the term 'Alarplasty' became popular among patients as well. Today, most patients use the term freely and know a lot about the procedure. I am very excited to see this evolution over the years. My African American patients were especially happy to learn that you can make the nose look small without having to do a full rhinoplasty. Many of them noticed that every plastic surgeon they went to offered a full rhinoplasty. 
In summary, Alarplasty is a unique procedure in itself and hopefully more surgeons get trained in it and help more people.
You can visit our alarplasty website to learn all about it. 
Click on the video link below to see the details.
Regards
Dr. J

William Portuese, MD · Answer

The width of the nostril holes is reduced with an Alar plasty, which has no bearing on the thickness of the skin on the ala itself. It is simply a reduction of the nostril size. 2 mm it will only give a very minimal improvement, most of the time we're doing a 4 to 5 mm reduction on each side in addition to releasing the lateral ligaments that wide the tip dynamically when smiling. A full set of facial photographs are required to make a determination about the amount of skin to be removed. This procedure can be performed under a local anesthesia is an outpatient procedure which takes about 30 minutes.

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