What can be done to widen the alar base other than putting ear cartilage inside the nostrils?

Alar base reduction is one of the most difficult steps in a rhinoplasty. It is truly one of those procedures that you need to measure about 5 times prior to making any cuts and it is imperative that you know what you are doing prior to making any cuts. Stenosis is a difficult problem. Ear cartilage can widen the nostril but it does nothing to correct the location of where the new nostril is inserted. It can be corrected with something called a transposition flap but it is not a perfect solution

To increase the width of the alar base after an alar base reduction is a tricky procedure. That being said it can be done with or without grafting just depending upon the shape of the nostrils and whether or not they need to be widened as well. A transposition flap can be used to draw out the nostrils further. I would recommend consultation with a board certified facial plastic surgeon in your area.

Yes, it can be accomplished using internal nasal flaps without any ear grafts. I use this technique quite often, depending on the shape & curvature of the nostril after the previous alar base excisional surgery. Otherwise, I use a composite graft (skin + cartilage) from the ear. Using the internal flaps just widens the nasal base without adding to the curvature of the nostril. The composite graft usually rounds out the attachment of the nostril as it inserts onto the face.