Alar Base Is Wide and Thick after Primary Surgery. Is a Suture Cinch Method The Right Call?

It's hard to be very specific without seeing your nose. I don't typically use cinching suture techniques when narrowing the nose. Check out my link below for a fuller description of some alar base narrowing techniques.

We do not recommend the cinch technique for alar base reduction due to multiple complications we have seen in our practice.  Complications include unnatural bunching of the upper lip area with breakage or infection of the suture itself.  A permanent solution is a simple Weir’s alarplasty incision at the base of the inside of the nostrils, which heals quite nicely.

Hi Mhappy;

With respect to, what I assume is, your desire to have the nostril walls narrowed by suture cinch may or may not be reasonable.  Frankly, I think you need some good evidence of how that works before you take it on.  It may be good, but each patient is different because the skin may be different, the muscle strength may be different, and be sure to discuss this in great detail.  If it works for you, that would be terrific. 

You asked about risk.  Generally, the risk has to do with dissatisfaction.  Is it possible that, over a period of time, the nostrils will widen again spontaneously.  This is always an issue when suture cinching techniques are used, but you can learn a lot by having your consultation focus on that issue, seeing many examples of that technique, and speaking to patients who have had it.  I think that is always the smart thing to do - ask to speak to people who have had the procedure.  Ideally, see them, meet them, and see how it looks to you.  If they are happy, you will be happy. 

Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

Cinching of the alar will have a minimal effect in the long term and no effect on the width of nasal base. You will need alar repostioning technique, a technique that I developed, whereby, the alae are reduced and repositioned medially. See the before and after photos.

Photos, of your nose from the base view and front would be required in order to make the determination if an alar bunching suture would be helpful.