Alar Base Reduction (Alarplasty): Complete Guide to Nostril Reduction Surgery

The Alarplasty Procedure: Techniques and What to Expect

Overview of Surgical Methods

Several techniques may be used during alar base reduction surgery, tailored to the individual’s anatomy and desired changes. The most common methods include:

• Weir Excision: A small wedge of tissue is removed from the outer base of the nostrils (near the cheek crease), allowing the nostrils to be drawn closer together. This method is ideal for reducing nostril flare.
• Nasal Sill Excision: A thin strip of tissue is removed from the floor of the nostrils, narrowing the base width between the two nostrils without altering the outer shape.
• V-Y Advancement: A method of repositioning tissue inward to slightly narrow nostrils without removing excess skin, typically used for more subtle refinements.

Often, surgeons combine techniques for the best results, ensuring the nostril size and shape match the overall nasal and facial structure.

How Surgeons Achieve Natural, Symmetrical Results

Achieving symmetry is a top priority during alar base reduction. Before surgery begins, your surgeon will carefully mark the planned incisions, often with you sitting upright to assess natural nostril positioning. 

During the procedure, small amounts of tissue are removed conservatively to avoid over-reduction, and constant comparisons between the two sides ensure even results.

Advanced techniques such as dissolvable internal sutures and placing scars within natural creases mean that, once healed, the surgical changes are virtually undetectable.

Step-by-Step: What Happens During the Procedure

• Anaesthesia: Alarplasty is usually performed under local anaesthesia with or without light sedation. For patients undergoing combined rhinoplasty, general anaesthesia may be used.
• Incisions: The surgeon makes discreet incisions either in the crease where the nostrils meet the cheek or inside the nostril floor.
• Tissue Removal or Repositioning: Carefully measured amounts of tissue are excised or shifted to reduce width or flare.
• Suturing: Fine sutures are used to close the incisions, ensuring minimal tension and scarring.
• Immediate Recovery: Patients can typically return home the same day, with a light dressing over the nose if needed.

The entire procedure usually takes 30 minutes to 1 hour when performed on its own.

Recovery After Nostril Reduction Surgery

Recovery after alar base reduction is usually straightforward, particularly compared to more extensive nasal surgeries. Most patients experience mild swelling and minimal bruising, with a gradual return to normal appearance over the following weeks.

A typical recovery timeline includes:

• Day 1–3: Swelling, mild discomfort, and slight oozing around the incision sites are normal. Pain is generally minimal and can be managed with over-the-counter medication.
• Day 5–7: Stitches (if non-dissolvable) are usually removed. Swelling begins to subside, and most patients feel comfortable returning to light daily activities or work.
• Week 2: Bruising and most visible swelling have resolved. Light exercise can often be resumed, but strenuous activity should still be avoided.
• Week 4: Final results start to become more visible. Any residual swelling continues to diminish.
• 3 Months: Scars mature and fade significantly. The nostrils take on their final, refined shape.

Every individual heals differently, but following post-operative instructions closely will greatly assist a smooth and quick recovery.

Caring for Incisions and Minimising Scarring

Proper wound care is crucial in the first few weeks after surgery.

To support optimal healing and achieve the least visible scars, patients are advised to:

• Keep incision sites clean and dry.
• Apply any prescribed antibiotic ointments as directed.
• Avoid direct sun exposure on the nose and use high-SPF sunscreen when outdoors.
• Refrain from applying pressure to the nose (such as heavy glasses) until fully healed.
• Avoid picking at scabs to prevent scar widening.

In most cases, scars are discreetly hidden along the natural creases of the nostrils and fade significantly within a few months.

Managing Swelling, Discomfort, and Breathing

Temporary swelling around the nostrils is expected, and it may initially make the nose look slightly larger before settling. Simple measures such as sleeping with the head elevated and applying cool compresses to the cheeks (avoiding direct pressure on the nose) can help reduce swelling faster. Breathing should not be affected by alarplasty. If you experience congestion, it is typically due to swelling and resolves as healing progresses.

Choosing the Right Surgeon for Alarplasty in London

To achieve the best outcome from alar base reduction, take your time to choose a surgeon with:

• Full registration with the General Medical Council (GMC)
• Specialist training in plastic surgery, ENT surgery, or facial cosmetic surgery
• Membership of professional organisations such as BAAPS or BAPRAS
• Specific experience in nostril reduction and ethnic rhinoplasty (if applicable)

Check Out Before-and-After Photos

Request to view before-and-after photos of previous alarplasty patients.

Look for:

• Natural-looking nostril shapes
• Minimal visible scarring
• Consistency in achieving symmetrical outcomes

This gives you a clearer understanding of the surgeon’s aesthetic style and technical skill.

Questions to Ask During a Consultation

Before committing to surgery, consider asking your surgeon:

• How many alar base reductions have you performed?
• Which surgical technique do you recommend for my anatomy?
• Where will my scars be placed and how will they heal?
• What is your policy if a minor revision is needed?
• What kind of aftercare support do you provide?

A top nose surgeon will answer all questions openly and make you feel fully informed and comfortable.