Alar base reduction pros and cons in revision rhinoplasty? Can an ethnic nose be narrowed without it?

Question

I plan on having a 3rd revision rhinoplasty to remove an implant & excess bulky scar tissue in the tip. A surgeon suggested alar base reductions to narrow a bulbous, heavy tip. What are the drawbacks for this in thick skin? I have rounded features & am worried about anything that will lead to what I hope to undo w/surgery 3--a bulky, unnaturally overprojected tip. What are the dangers of alar base reduction, other than keloid scarring? Can is lead to nasal collapse or pinching?

George Bitar, MD · Answer

Thank you for your question. Alar base reduction is used to reduce alar flaring by resecting skin at the base of the nose. Negative side effects include over narrowing of the nose giving an unnatural appearance, tip necrosis if resected too high, an unfavorable scar and external nasal valve collapse. It is not used to address tip issues.  Discuss this matter further with your surgeon.

Steven Wallach, MD · Answer

Alar base reduction surgery is often performed for either flare, excessive width or both.  It is a very good procedure when done correctly.  Scarring is usually not a problem with incision along the nasal sill or floor.

Sean Freeman, MD · Answer

irsi, I prefer not to alter the shape of the nostril at the time of the rhinoplasty, whether it is a revision or a virgin nose. 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 after your revision and then talk it
over with your surgeon. Good luck!

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,Alar base reduction will not alter your bulbous tip. As with any incision on the face, hypertrophic scarring can be a potential complication. If the incisions are done correctly then that should not be an issue. That said, I have never seen keloid formation on the nose but hypertrophic scarring is a consideration.Best,Dr.S.

Alar base reduction pros and cons in revision rhinoplasty? Can an ethnic nose be narrowed without it?

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