Of the many components that make up the nose, one of the most overlooked by patients is the width of the nasal base, known as alar width or how wide or flared the nostrils are. The horizontal width of the nostrils (alar base) does play an important role in the overall appearance and proportion of the nose. Overly wide or flared nostrils can give the appearance of a bottom heavy nose and can throw off the balance of a well shaped and balanced bridge of the nose and the nasal tip. They can also detract from an otherwise well done rhinoplasty result.
Most would not give too much thought to what makes up the proper or most aesthetically pleasing width of the nostrils. Classic teaching is that the width of the alar base should be about equal to the distance between the inner part of one’s eyes, known as the inner canthus. If you dropped a vertical line down from the inner angle of the eyes, the skin of the nostril should touch the line or just go a few millimeters beyond it. This ideal width may change somewhat amongst different races (may be a little wider in African-Americans and Asians) but significant variances from this vertical line is not aesthetically pleasing.
Nostril (alar) size reduction is usually done as part of a rhinoplasty operation. It is fairly easy to determine if this procedure is needed by whether the patient points it out as an issue, by measurements done on the patient and, most importantly, by computer prediction imaging prior to surgery. However, there are a few instances when the width of the nostrils can be changed by what is done during rhinoplasty surgery and your plastic surgeon will point this out to you beforehand should that be a concern.
Alar reduction is usually performed as the last step in the rhinoplasty operation. There are several methods for narrowing a wide or flared nostril. In cases of minor flaring, a wedge of tissue is taken from the inside of the nose from the nostril floor. This will only reduce the alar flare slightly by bending in the inside curve of the nostrils. While the scar is completely hidden, the nostril changes are subtle and certainly conservative. Most commonly, alar flare reduction is done by removing a complete wedge of tissue from the inside of the nose that crosses onto the crease along the visible base of the nostril. This results in a more significant nostril narrowing at the expense of a very small scar that heals usually to the point it is imperceptible.
In my Indianapolis plastic surgery practice, I find that the need for alar base reduction is needed in less than 10% of the rhinoplasty surgeries that I do. When done, it adds nothing to the recovery time of the operation, requires no care afterwards (sutures are dissolveable), and takes very little extra operating room time to do. In the properly selected patient, alar base reduction can be a subtle procedure that improves a rhinoplasty result.
Dr. Barry Eppley
Indianapolis, Indiana