How Do I Know if I Had Alar Base Reduction?

After surgery I had stitches on the creases of my nostrils (where the nostril meets the cheek). Almost a year post-op I am feeling pain in this area on both sides as well as irritation. I asked my surgeon if he did an alar base reduction or (anything in this area) and he denied it. He claimed that stiches always have to be put in the creases after an open rhinoplasty when the surgeon "cuts into the nose."

If this is irreversible, I will be very disppointed. I did not request this at all. Why would the sides be in so much pain this far along if nothing serious was performed? How do I find out if this was done? It wasn't in the operative report.

Doctor Answers 4

Alar Base Pain

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The incision for an open rhinoplasty is made in the columella (the strip of skin between the nostrils) . If incisions are visible at the base of the nose, you probably had alar modification. Ask to see pre-op pictures and compare with your present appearance. It difficult to explain the persistent pain this long after surgery. I recommend a second opinion; it sounds like you have lost confidence in your original surgeon.

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Alar base reductions do have stitches at the base

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Alar base reductions do have stitches at the base of the creases of the nostrils where it joins with the upper lip and cheek. If there is still pain and irritation in those areas, there could potentially be a stitch abscess underneath that is creating an inflammatory process. It may have to be re-explored and any stitch that may be present would be removed. The alar base wedge resections are permanent and are not reversible.

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

Unwanted Alar Base Reduction During Rhinoplasty With Pain One Year Later

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Hi Fashion Gal,

The visible sutures from an open or external approach rhinoplasty are located in the mid-columella or the center divider between the nostrils (when the nose is viewed from below). The only reason for sutures in the "creases" where the nostril meets the cheek is alar reduction. If you had sutures in that area, then something was done to the ala. The nose should also appear narrower from the base view (again from below). Lastly you can be examined by a rhinoplasty specialist who should be able to tell you if your alar base was altered.

I am at a loss to explain why you are having tenderness in the area. You experience also underscores of the importance of precise communication of the surgical plan between surgeon and patient before the operation.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

See a revision rhinoplasty specialist

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It sounds like you had alar base incisions and you can tell this by looking for the scar where the base was cut. Even if this was cut, you should not be having a problem at this late date. See an experienced rhinoplasty revision expert to discuss your options.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 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.