Alar base reduction can't or shouldn't be done at initial rhinoplasty?

At a recent Rhinoplasty consultation I was told that an alar base reduction could not be performed at the same time as the initial Rhinoplasty as it would be to difficult to make the correct alterations. If a reduction was needed I would have to wait until all swelling from my initial surgery subsided. Is this the common method?

Doctor Answers 11

Staging alar base reduction?

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If it is clear that you are going to need an alar base reduction I like most plastic surgeons would perform it at the conclusion of your rhinoplasty procedure.  I have not heard of staging the procedure except in the unusual case where allowing for healing to occur may clarify whether the procedure is even necessary.  Under most circumstances patients and surgeons prefer to combine the procedure under one anesthetic and operating room visit.  Regards

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

Alar rim

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royalblueformetoo, I'm happy to read you saw a good surgeon; this is a topic I've been pushing at our Academy for years. I wait until the tip has settled and presented itself to the point that I feel comfortable taking this step. Why do I stage this? First of all it is not reversible so if one takes this step it must be done as precisely as possible. Secondly, when I change the projection, orientation and shape of the nasal tip it will change the shape of the nostril in a way that is unpredictable which harkens back to my first point. Finally it is a patient friendly step, can easily be done under straight local, with minimal bruising, swelling and post op discomfort. So give yourself 2-4 months and then talk it over with your surgeon. Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

Alar base reduction

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Thank you for your question!  Alar base reduction can be a wonderful adjunct procedure after a rhinoplasty is completed.  As I tell my patients, though, the reduction is a maneuver that cannot be reversed.  Therefore, some surgeons like to wait to perform the reduction until all swelling from the initial surgery is completed.  

This being said, I will typically perform alar base reduction, in the correctly selected patients, during the initial rhinoplasty.  In addition, I always caution my patients that I am conservative with the reduction, and we can always take more a later date.  Be sure you are consulting with a fellowship-trained, board certified facial plastic or plastic surgeon who specializes in rhinoplasty.  

I hope that this helps!

-David Gilpin

David Gilpin, MD
Nashville Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

Alar base reduction

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For most patients alar base reduction, if indicated, is done at the time of the initial surgery. I usually leave that as the last step in the operation after all the other proportions of the nose have been adjusted. While it certainly can be done at a later date, usually in-office under local anesthesia, there's little reason to suggest routinely staging these procedures rather than just taking care of it at the original operation.

All the best,


Pearson Facial Plastic Surgery®

David C. Pearson, MD
Jacksonville Facial Plastic Surgeon

Alar base reduction during or following rhinoplasty

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Alar base reduction can certainly be done at the time of rhinoplasty surgery.  In situations where it may be of borderline benefit it is not unreasonable to wait, allow for healing and then reconsider.  But if it is clearly needed  it is better to do the alar base procedure with the rhinoplasty.  

J. David Holcomb, MD
Sarasota Facial Plastic Surgeon
4.6 out of 5 stars 32 reviews

Alar Base Reduction

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It would be more common to have alar base reduction done at the time of the rhinoplasty. The only reason for deferral is if there is uncertainty as to whether the procedure is needed at all.

Alar base reduction

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Every surgeon has her/his own approach but generally speaking Alar base reduction or Alarplasty can be safely done at the same time as a rhinoplasty. 


Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

Alar plasty with a rhinoplasty procedure

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In our practice, we perform in an alar base reduction at the same time as the rhinoplasty procedure.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Alar base reduction

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If done properly, it can be done with the primary rhinoplasty.

This is the first time I heard of staging an alar base resection.

Dennis Barek, MD (retired)
Great Neck Plastic Surgeon


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Hello and thank you for your question. I frequently perform alar base reduction at the same time as rhinoplasty.  I do not agree with the need to separate these procedures at all.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 174 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.