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Nostril/Alar Base Reduction in NYC

Rhinoplasty

In some noses, the base is wider than it should be and a nostril reduction may be required. This occurs more commonly among Ethnic Rhinoplasty surgery such as African American rhinoplasty, Asian rhinoplasty, Hispanic/Latino rhinoplasty, or Middle Eastern/Mediterranean rhinoplasty surgery. Dr. Sam Rizk, a New York City Rhinoplasty specialist, can remove a wedge of tissue at your nostril bases and he usually does it from the inside part of the nostril, not from where the nostril attaches to the cheek. Dr. Sam Rizk feels that making an Alar Base reduction incision on the outside of the nostril where it connects to the cheek makes the scar visible and he prefers to hide the scar on the inside part of the nostril. The procedure is sometimes called a Weir excision. This technique can narrow your nostril bases, reduce the length of your nostril sidewalls, and make your nostrils smaller, depending on the design of the wedge excisions.

A Weir excision is performed if your nostril bases are wider than ideal (see diagram below). Ideal is difficult to define and depends on many factors, including size of face and mouth and width of nose, but an imaginary vertical line drawn from the inside border of the eye is generally used as a guide for the outside border of the nostrils. So in other words, the nostrils should lie within and not outside this imaginary vertical line. If you have an exceptionally protruding nasal tip and your tip projection is reduced surgically, the rims of your nostrils may flare and appear too large and buckle outwards and weir excisions can solve this problem. They can also be used to make oversized nostrils smaller.

The scar Dr. Sam Rizk modified for Weir excisions sits hidden on the inside of the nostrils and are almost virtually invisible. In any case, the benefit of the excision outweigh any negatives of a small scar. The diagram below shows the incision lines (in red) typically used for weir excisions.

Dr. Rizk has also innovated use of a special suture that narrows the base of the nose that goes under the skin from nostril to nostril in the area under the nose. This suture can also narrow the base of the nose and is placed from an internal incision inside the nose. Sometimes, Dr. Rizk uses this suture alone or in combination with a Weir Excision.

Dr. Rizk also looks at the size of the mouth and width of the mouth and cheeks to create a balanced face and reduction is done to be in harmony with these structures. Dr. Rizk further has a technique of rotating the nostril so they don't create a pointy look at the upper part of the nostril, typical of older reduction and a bad tell-tale sign of rhinoplasty. Dr. Sam Rizk's technique maintains the natural architecture and curved shape of the nostril while making them smaller.

Asymmetries in size, shape or thickness can also be corrected with various nasal techniques which may involved cartilage grafts or fat removal or addition. Some nostrils are very collapsed and straight from previous rhinoplasty surgery and a revision rhinoplasty with either fat injection or a cartilage graft into the nostril can recreate the natural curvature of an attractive nostril. Poor scars from a previous reduction which was unsuccessful can sometimes also be improved, depending on where the scar was placed and whether it was in a natural crease or visible.

Frequently Asked Questions on Alar Base Reduction

What is Dr. Rizk’s experience with alar base reduction?
Dr. Sam Rizk has double board certification in facial plastic surgery (see board certification section of this website). Dr. Sam Rizk has had extensive training in both cosmetic and reconstructive rhinoplasty at New York’s best hospitals including Memorial Sloan kettering Cancer Center and New York Hospital as well as Manhattan Eye, Ear and Throat hospital. He has performed very difficult adjustments in cancer patients after cancer removal which requires significant artistry and ingenuity more than a simpler reduction. Dr. Rizk also has a specialization in ethnic rhinoplasty, many require a reduction as part of the rhinoplasty procedure. In addition, Dr. Sam Rizk does nostril adjustments on patients with cleft lip/palate who tend to have very significant asymmetries and require major grafting and adjustments to make their nose and nostrils more symmetrical. With this experience, Dr. Rizk is able to modify the various techniques and has innovated his own modifications of techniques to achieve a nostril that appears normal, rounded, and with a hidden scar on the internal part of the nostril, rather than a scar on the outside part of the nostril.

How does Dr. Sam Rizk determine who is an appropriate candidate for a nostril reduction?
Alar base reduction is done for nostrils that are too wide and may be performed as an isolated procedure or in conjunction with rhinoplasty. There are certain guidelines for nostril position in comparison to the nose and other facial structures but ultimately the surgeon’s artistry and vision for your nose determines if a nostril reduction is performed and how much is removed. Dr. Sam Rizk is very conservative with nostril reductions since you cannot put them back. If Dr. Rizk performs an Alar Base Reduction during a rhinoplasty procedure and you want more take out at a later time-this is an easy touch up procedure done under local anesthesia. These reductions can be performed on large or flaring nostrils or on asymmetrical nostrils. Dr. Rizk determines if nostrils are flaring based on an imaginary vertical line dropped from the inner part of the eye. The nose and nostrils should be within this vertical imaginary line. If the nose does not lie within this line then a nostril reduction should be performed. Also, sometimes Dr. Rizk will perform a nasal reduction only on one side if one nostril is larger than the other. Sometimes nostrils are collapsing from previous nasal surgery and will require a cartilage graft to create a natural curved appearance and correct the collapsed pinched areas. Nostrils can also vary not just in size but also in thickness or horizontal insertion into the face, one being higher or lower than the other. These other variabilities in nostrils can be improved, although it is important to understand than complete symmetry is impossible in an already asymmetric nostril.

Where are incisions performed for nostril reduction?
Incisions can be performed on the inside part of the nostril as in a Weir incision or a modified Weir incision or on the outside curvature of the nostril where the nostril inserts into the cheeks. Dr. Rizk uses an internal incision in a modified type of Weir excision where he rotates the nostril to make them narrower in a natural position without a visible scar. Dr. Rizk does not perform external nostril incisions on the outside curvature of the nostril as the scars are usually very visible and may be difficult to hide. Dr. Rizk’s technique for nasal reduction is unique and has been developed over many years to minimize scars and achieve a natural contour to the nostrils.

What is the nasal sill and when does Dr. Rizk do a sill excision?
The sill is the distance from the parting middle piece of skin separating the right and left nostrils called columella to the internal border of the nostril. Sometimes the sill is too long and makes the nose appear wide. If only the sill is wide and the nostril curvature is normal, then only a sill excision can be performed from a small internal incision to medialize or bring the nostrils closer to the middle part of the nose. A sill excision must be done conservatively in order not to diminish airflow and nasal breathing. If both the sill and nostrils are large then a combined sill-nostril excision can be performed.

When is a reduction performed during a rhinoplasty procedure?
Dr. Sam Rizk performs an alar base reduction as the last part of a rhinoplasty procedure for several reasons. First, tip surgery can affect the shape of the nostrils so the tip should be performed first. If the tip needs to be projected , this can bring the nostrils in more and make them narrower. If the tip needs to be deprojected or brought closer to the face, this can make the nostrils flare more.

Does a nostril reduction prolong the healing from a rhinoplasty?
No, Dr. Rizk removes the sutures around the nostril at the same time as the cast from the rhinoplasty is removed at one week after surgery. The reason Dr. Rizk uses removal stitches instead of dissolvable ones is for better healing. The dissolvable sutures would leave little red dots as they dissolve but the removable sutures do not leave a mark after removal.