Is an internal or external incision for alarplasty more effective for narrowing the width of nostrils?

Question

I was told by a person who was informed by a clinic that an internal incision is the most effective of the two at getting the most drastic results. However, search results online have said otherwise. I would greatly appreciate if someone could help clear this up for me. Thank you!

Donald B. Yoo, MD, FACS · Answer

The truth is a combination of external and internal incisions will create the most significant narrowing and reduction of flare. Paramount to success is preserving a natural amount of curvature so that the nostrils don't appear "pinched" or "stuck on" while balancing the width of the nasal tip.

Tanveer Janjua, MD · Answer

The external incision is the only way to get drastic results. 
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 mimick 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.

Barry M. Weintraub, MD, FACS · Answer

It depends on the width of the nostrils. If someone has exceptionally wide nostrils, an alarplasty with external incisions is typically employed. These external incisions are placed in the crease between the nostril base and the face. If the surgeon is highly skilled, this incision can be nearly invisible, but in my practice, I prefer whenever possible removing a small wedge from the internal nostril base. I have found that with patients who possess a mild-to-moderate nostril width, the removal of a small wedge from the floor of the nose effectively moves the nostril base closer to the columella on each side, thereby narrowing the nostrils *without* an external scar. Every surgeon is different, but in my practice, I prefer the most conservative and natural look, which is why I often use the technique of the internal incision.

William Portuese, MD · Answer

More information is needed, such as pictures of your whole nose, and up the nostril view to make sure you're a candidate for an Alar plasty. In our practice, we make about a quarter inch incision, which is halfway on the inside of the nostril, and halfway on the outside right at the base of the Alar sill. This procedure can be performed under a local anesthesia, which takes about a half an hour.

Is an internal or external incision for alarplasty more effective for narrowing the width of nostrils?

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