Nasal sill/Alar Base Reduction (Photo)

Question

Does Excess nasil sill flatten the alar and expand it more than it should typically be? And what would be the best approach for a nose with a wide alar base. If someone wants to maintain that natural curve also.

Semih Yildiz, MD, FEBOPRAS · Answer

I reviewed both close-up photos of the alar and nasal-sill area. They show the region of concern, but close-ups alone cannot determine whether the apparent width comes mainly from the sill, the alar cartilage and soft tissue, the nasal floor, the tip framework, or movement with smiling. A frontal view at rest and while smiling, as well as an in-person examination, is important.

Nasal sill reduction and alar-base reduction are related but not identical. Depending on the anatomy, a surgeon may consider a limited sill excision, an external alar-base/Weir-type excision, conservative tissue reshaping, or no reduction. The goal is not simply to remove width: taking too much tissue can flatten the natural alar curve, distort the nostril, create asymmetry, produce visible scars, or narrow the airway. The incision design and amount removed should be based on measurements, the nostril shape, the alar-facial relationship, skin thickness, and how the nose moves when you smile.

Please see a board-certified facial plastic surgeon or rhinoplasty specialist who routinely performs conservative alar-base surgery. Ask to review comparable before-and-after cases and discuss exactly how much narrowing is realistic while preserving the natural curve and breathing. Do not use filler to camouflage a structural concern without a careful assessment. If you have current obstruction, recurrent crusting, pain, redness, drainage, or a rapidly changing appearance, arrange an earlier examination.

Eric M. Joseph, MD · Answer

It's difficult to evaluate the up close photos of your nose. It looks like one of your photographs has markings, and that would be a reasonable place to leave an alar plasty scar. For a more definitive answer, please consider asking your question with more descriptive photographs. Thank you. Sincerely, Dr. Joseph

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question hereI will start by stating that my answer is based on the limited information and pictures provided, for a more detailed/ bespoke answer please consult with a plastic surgeon in person.
It is hard to tell with the pictures provided what the need is but in general for wide nostrils were the sill is redundant a nasal sill excision is usually the best approach (the incision will be placed in the sill on the inside of the nostril), if it is pure flaring of the ala/the ala is redundant then a weir excision is in order (the incision will be on the base of the ala on the outside) 
I hope this helps, best of luck!

Ronald J. Edelson, MD · Answer

There are many different patterns for alarplasty and each surgeon might recommend something different depending on what you want accomplished

Tanveer Janjua, MD · Answer

The width of the nasal sill contributes to the width of the nostrils. The markings you have made are a good approximation of what kind of incisions are needed. Typically for alarplasty these are similar to the incisions I use. 
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

Oakley Smith, MD, FRCSC · Answer

Hi, It is better for you to consult with your facial plastic surgeon who can examine you and give you opinion based on examination.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. It would be helpful to view pictures of your entire nose. An internal sill incision would likely be able to decrease the width of your alar base. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Nasal sill/Alar Base Reduction (Photo)

Answers (7)

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