Is 2mm the standard for Alar Base Reduction? (Photo)

Question

I just had an appointment with a doc I really like who did my rhinoplasty five years ago. Ive been happy with the way I look but recently became self conscious again about the overall size. I thought if I narrowed the base then I might stop thinking about my nose everyday again without going into the drastic measure of a second rhinoplasty. He said I would be a good candidate and mentioned reducing the nostrils by 2mm on each side. Is that standard? Is that enough? Thank you!

Richard H. Tholen, MD, FACS · Answer

Just as no two noses are alike, neither is there a "standard" alar base reduction. Your nose looks pretty good right now, so I'm not really sure why you are obsessing. What? You're NOT obsessing! Well, then, OK, 2mm is a modest reduction that will probably not give you airway obstruction and make you regret the request for more nose shaping.Without actually examining you in person and observing nasal airway dynamics and flow, it is inappropriate for me to say this is not a good idea, but too much alar reduction and you WILL  have airway concerns. Try breathing through two soda straws right now. Put them in your mouth and pinch you nostrils shut. See how you do with this and then extrapolate breathing this way through your nose FOR THE REST OF YOUR LIFE.Maybe 2mm is too much? Discuss in detail with your surgeon. Really!Your nose really does look great! Enjoy good breathing and being beautiful. Best wishes! Dr. Tholen

Houtan Chaboki, MD · Answer

Alar base reduction (nostril narrowing) can be performed for wide or large nostrils. A variable amount of skin is removed, anywhere from approximately 1mm to 5mm per side. The more skin removed, then the more significant the change on the nose and appearance. For the nostrils, plastic surgeons often may suggest a "less is more" approach and be more conservative. If you've been happy with the nose already, then leaving it alone is a very good option. Based on the information provided alone, you don't appear to be a typical candidate for alar base reduction.Best,Dr. Chaboki

Philip S. Schoenfeld, MD, FACS · Answer

Your question is a good one and in some ways it reads as a commentary.  I like the result of your nose.  I suspect other people like the appearance of your nose as well.  On the photo that you have provided your nostrils do not appear to be significantly out of proportion to the nasal tip, and the alar position compared lines up nicely to the position of the medial canthus of your eye.  Having said that, alar base reductions in rhinoplasty can be a very effective means of narrowing a wide nasal base in the proper noses.  I have reduced the alar base in rhinoplasty very small amounts but 2mm may really be pushing the envelope a bit.  If you have confidence in your surgeon then by all means, proceed with the surgery but the enemy of really good is better.

Robert Galiano, MD · Answer

You certainly have a lovely result from your initial rhinoplasty. Alar base reductions can really complement the final result. A 2 mm reduction is certainly an "average" reduction, but keep in mind that this varies among different patients - some ethnic patients require significantly larger reductions and other components reduced as well. If your concern is having overly reduced nostrils I do not think you need to worry.

Adam Bryce Weinfeld, MD · Answer

I perform alar base reductions in about 20% of my rhinoplasties.  If patients don't want to have it done, I don't.  But it can be powerful when indicated.  I often make the final decision to do the reduction during he surgery after all the other changes have been made.  If there is any doubt, i don't do it at the time of the initial operation but reconsider it later.  I can be done in the office later with minimal recovery.  Alar base reductions can be as small as 1 mm and are rarely more than 3mm  - thus 2 mm is common in my practice.

Stephen Weber MD, FACS · Answer

The standard is whatever excision will place the attachment of the nostrils to the cheek just inside the inner corner of the eye. 2mm is not unreasonable but the ideal amount will vary from person to person. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Mario J. Imola, MD, DDS · Answer

Alar base reductions vary in shape and size from patient to patient depending on the individual situation.Mario J. Imola, MD, DDS, FRCSC, FACS.

R. Stephen Mulholland, MD (retired) · Answer

Dear ladybugg13,

Thank you for your clinical post and photograph.  From the front view shown you appear to have
a very nicely shaped nose.  The dorsal
bridge anatomy and tip projection can’t be assessed from the views provided,
but the nasal tip appears refined as does the nasal bridge.  There is a little nostril asymmetry and a
slight degree of hanging columella and reduction of the right nostril and to a
lesser extent the left nostril provide an additional narrowing effect.

Subtle removal of member’s columella for the hanging
columella will also improve nasal tip aesthetics.  It is important to remember that you appear
to have a nice result and rhinoplasty revision can sometimes be fraught with
peril and can leave you with a result that you then don’t like.  The absolute amount of the alar base
resection depends upon the amount of nostril alar splay.  Generally, most surgeons want a proportional
nasal tip bridge anatomy where the outer most aspect of the nostril alar line
up with the medial canthus.  However, in
scenarios where the medial canthus is slightly wide, the nasal bridge is
inadequately projected then additional nasal alar reduction may need to be
performed.  In your situation where there
is some nostril alar asymmetry, more might need to be removed from the right
side than the left.  I have performed
nostril alar reductions as small as 2 mm and as great as 6 mm depending on the
needs of the nasofacial balance and proportion.

I think you have a good result and excellent opportunity to
maintain, sustain and improve upon that result with careful selection of the
techniques offered.  You sound like you
have a good rhinoplasty surgeon who’s conservative and sometimes that’s the
best.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

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