Alar Base Reduction: Nuances and Techniques

Treatment of nasal base deformities is critical for a successful rhinoplasty. Several anatomic variations are seen on nasal base. Alar base deformities can be horizontal excess or deficiency, vertical excess or deficiency, cephalic malposition or caudal malposition of alar base, wide or narrow nostril sills, and columellar base deformities. Columellar base should be addressed before alar base resections. Correction of columellar base deformities and positioning of medial crural footplates should be the primary step of nasal base surgery to attain aesthetic ideals of the columellar base and improve external nasal valve function. The most common deformities requiring alar base modification include wide nasal base, alar flaring, large nostril size, and asymmetries of nostrils or alae. There are 3 basic types of excision on alar base surgery. (1) Alar wedge excision, (2) nostril sill excision, and (3) combined alar wedge and nostril sill excision. The alar wedge excision is an elliptical excision placed in the alar crease that is used to reduce the size and shorten the vertical length of alar lobule and correct the excessive flaring on the frontal view. Nostril sill excision is the technique which is used to decrease interalar distance and nostril sill length, and reduce the size of nostril. The combined alar wedge and nostril sill excision is used in cases with wide alar base and additionally, there is excessive flaring and large alar lobule.