Very Unusual Alar Base Question/Dilemma. Who Can Figure This Out? (photo)

My problem? Love my nose. But, only love it when I tense up the muscles near it! This has the effect of making it look thinner/more defined.--When relaxed, the nose looks wide. If I tense up, it pulls the nostrils in closer together while pulling them down slightly.-- How i can get my nose to look the way it does tense, when I'm relaxed. Dr. said, "Patients from India often want alar bases positioned lower to match the columellar show, not just narrowed." Anyone take a crack at this?

Doctor Answers 6

Alar Base Surgery To Reduce Nostril Sills

To surgically mimic the tensing of the base of your nose to narrow your alar base and therefore reduce the width of your nostril sills, I would use two permanent sutures, each a cerclage, from the base of each ala circling through the base of the upper lip.  This was well described several years ago by Dr. Ron Gruber of Oakland, California.  

Secondly, if I am understanding you correctly, you want to lower the position of the alar base, vis-a-vis the proximal portion of your columella.  To do this, I would raise the proximal columella by resecting a small portion of the proximal caudal septum along with a small piece of proximal membranous septum.  My point here is, since lowering the alar bases would be scarring and look unusual, and since it is a relationship thing, just raise the proximal caudal septum and associated membrane, and you get the same effect. 

Dynamic alar base shaping

If you like your alar appearance when you tense the muscles near the alar, then you really have two different options. First you may consider using Botox to relax the counter muscles which can mimic when you are tensing the alar base muscles. Second, you can consider nasal base spanning suture to move the alar distance a little closer. You can also incorporate nasal sill base reduction to further lower your alar position. Because this involves dynamic anatomy, video would be much clearer. Of course best choice would be the in person consultation.

Stewart Wang, MD FACS

Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

Nostril Narrowing/Repositioning

There are only two fundamental procedures for modifying the nasal base/alar width. One approach is an excision of skin  from the nostrils, done in several ways, to narrow them and is best thought of as a static or resting procedure. The other approach is an internal suture technique that spans under the nasal base to cinch the nostrils inward and is best thought of as more of a preventative or dynamic procedure, meaning it prevents flaring during smiling animation. Based on your description you are describing changes that are best treated by a static approach through nostril base excision. Based on the skin cutout pattern along the nostrils, they can be brought both inward and downward.  

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Alar base narrowing

It is possible to narrow the width of the nose with osteotomies and a tip plasty can also be performed to narrow the tip cartilages.  Rhinoplasty is performed when the nose is static and not for dynamic reasons with the exception of releasing the depressor septi ligament.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Alar reduction

Arriving the nostril base is a common procedure called alar wedge excision.  It involves removing a crescent of skin from the nostril with the scar hidden in the nostril crease.  It is an simple and standard procedure and sounds like it would accomplish what you desire.  Good luck!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Alar bases too wide: rhinoplasty?

Your request is very common.  Alar base narrowing, with or without adjusting columellar show, is a straightforward part of the rhinoplasty surgeon's tool set.


See a Board Certified Plastic Surgeon who has had a lot of experience with rhinoplasty, and be sure to see a complete portfolio of pre- and post-op pictures so you can see what types of results are reasonable.  In rhinoplasty, more than for many other types of procedures, surgeon experience is very important.

Daniel Greenwald, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 45 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.