Modified Technique for Simultaneous Alar Base Narrowing and Nostril Reduction in Asian Rhinoplasty: With a Video...

Conventional alar base excision, which places incisions anterior to the alar-facial groove, frequently leads to conspicuous scarring and iatrogenic nostril deformities. This technical note describes a modified combined sill and alar excision technique in which the incision is precisely positioned within the natural alar-facial groove and closed exclusively with intracutaneous sutures. Key surgical steps include (1) preoperative marking of the nasal sill and alar-facial groove; (2) incision placement strictly within the alar-facial groove; (3) customized tissue resection based on individual anatomic assessment; (4) medial rotation of the alar flap to optimize contour and projection; and (5) layered wound closure, with intracutaneous suturing reserved exclusively for the alar component. Outcome measures comprised the interalar-to-intercanthal distance ratio, qualitative assessment of nostril shape and symmetry, scar evaluation using the visual analog scale (VAS), and incidence of postoperative complications. A statistically significant reduction in the interalar-to-intercanthal distance ratio was observed. Horizontal nostril configuration decreased markedly, whereas the proportion of ideal pear-shaped nostrils increased significantly. Nostril symmetry improved across all cases. VAS scoring indicated that the majority of patients reported their scars as imperceptible or nearly imperceptible. No cases of alar deformity, infection, or hypertrophic scarring were observed. The modified combined sill and alar excision technique-featuring groove-precise incision placement and exclusive intracutaneous closure-provides a safe, effective, and reproducible solution for concurrent alar base narrowing and nostril refinement in Asian patients. It delivers predictable aesthetic outcomes, well-concealed scars, and harmonious, natural-looking nostril geometry.