Have you ever looked at a photo of yourself and thought, "My alar base seems to stand out..." and felt troubled? It's a difficult area to conceal with makeup, and it easily becomes a source of insecurity.
Many people think, "I'm scared of surgery, so I want to make it smaller without cutting," but the most suitable treatment method varies greatly depending on the shape and cause of your alar base.
While referencing data from international medical literature, we will classify the causes of enlarged-appearing alar base by concern, explain the treatment options suitable for each, and discuss the medical limitations.
By objectively understanding your own condition, we hope this will serve as a useful reference for considering treatment options—from cases where non-surgical treatment may be appropriate to risk management strategies in surgical procedures.
The "True Cause" Behind Feeling Your Ala is Large
While we often say the ala (alae nasi) is large, the causes vary—from skeletal andcartilageshape to skin thickness and more. In the world of aesthetic medicine, there are clear standards that form the basis of what is considered a beautiful nose.
The width of the alar base (the root of the nostrils) is often considered well-balanced when it is approximately equal to the distance between the inner corners of both eyes (intercanthal distance). According to multiple research reports, a statistical reference value of approximately 31–33 mm is reported as a population average; however, this is not an absolute standard that determines individual aesthetic balance.
Additionally, when the fullness of the alar wing projects outward beyond the alar base, this condition is called "alar flaring." In some research, when such flaring measures 2 mm or more, it is sometimes used as a reference indicator for considering treatment; however, actual candidacy is determined comprehensively by considering functional aspects (such as effects on nasal breathing), overall facial balance, and patient preference.
The lower lateral cartilage (LLC), which forms the shape of the nasal tip, is an extremely thin and delicate tissue. The shape and strength of this cartilage have a significant impact on how widely the nostrils spread.
In anatomical research, as an average population trend, it is sometimes reported that the noses of East Asian people tend to have relatively lower nasal tips and wider nostrils compared to those of Western people. However, it is important to understand that this is a statistical tendency and individual variation is very significant.
In a study of 300 Asian women, alar enlargement was classified into three types: "vertical enlargement (too high)," "horizontal enlargement (too wide)," and "bidirectional enlargement."
Furthermore, the sides of the nostrils lack direct cartilage support and maintain their shape through a network of fibrous connective tissue (subcutaneous tissue).
The reason for enlarged nostrils is not simply excess skin,but rather a high likelihood that the cause lies in the structure of the internal cartilage and fibrous tissue itself.
Is non-surgical alar base treatment effective? Applicable cases and limitations
"Downtime" cannot be taken" or "surgery is frightening," non-surgical treatments using injections or medical-grade threads may also be options. For example, botulinum toxin injections temporarily weaken the muscles that widen the alar base when smiling, while threads physically draw tissue together. These can be effective for mild improvements or suppressing dynamic flaring, but the effects are not permanent, and risks such as infection, asymmetry, and rebound must be considered.
According to treatment algorithms published in medical journals, alar flaring is finely classified from "Type 1" to "Type 4" based on the location of maximum protrusion.
For Types 1–3 where flaring alone is the issue, "alar base reduction (wedge resection)" is indicated. Conversely, when the width of the alar base root itself is broad, resection of the nasal sill (the floor portion of the nostrils) is necessary.
In many Asian individuals, "Type 4"—which combines both flaring and width—is common, and combined resection (alar base resection + nasal sill resection) is performed.
Critical is precise design of the resection area. A design that preserves approximately2 mmof the vertical skin of the nasal sill is proposed as one guideline to prevent unnatural notching, though adjustment based on individual nasal shape and skin thickness is necessary.Rohrich et al. (2020)similarly strongly recommend this preservation standard in a systematic approach.
Additionally, suturing technique to heal scars beautifully is important. Placing deep sutures should be avoided, and it is recommended to carefully align only the skin edges using ultra-fine sutures such as 6-0 nylon.
By not tightening sutures excessively, avoiding suture tracking marks, and following a schedule of suture removal at 7–10 days post-op, aesthetic results are enhanced.
"Nasal balance with the nasal tip" to consider before alar base reduction
While it is natural to think "my alar base is large, so I should have alar base reduction," it is extremely important to pause once and confirm "nasal balance with the nasal tip" to avoid complications. In fact, the prominence of the alar base often stems not from the size of the alar base itself, but from a low or poorly shaped nasal tip.
Excessive resection carries the risk of greatly distorting nasal harmony and causing unnatural deformity. It is cautioned that conservative tissue removal is far safer than excessive resection.
Additionally, surgical techniques that excessively resect the cephalic portion of the lower lateral cartilage to reduce volume at the tip of the nose can lead to epithelial contraction (shrink-wrap, contracture).Contracturemay cause)\n```\n\nWait, let me reconsider. The Japanese text is "）を引き起こす可能性があります。" which translates to:\n\n```json\n[") may cause."]\n```\n\nHowever, this appears to be a sentence fragment. The closing parenthesis "）" suggests this is part of a larger sentence. A more complete translation would be:\n\n```json\n[") may cause."]\n```\n\nOr if the context includes what comes before:\n\n```json\n[") may cause."]\n```\n\nGiven only this fragment, the most literal translation is:\n\n```json\n[") may cause.
When this contracture occurs, it becomes a cause of a serious complication called postoperative secondary alar retraction (PSAR: a condition where the edge of the ala nasi is lifted upward and the nostrils become prominent).
As a state-of-the-art countermeasure against such risks, a technique called "alar base lining graft (ABLG: Alar Base Lining Graft)" has gained attention.
This is an advanced technique in which excess skin removed during alar reduction is not discarded but is re-transplanted as a dermal-epidermal graft (measuring 1.0–0.3 cm in length and 1–3 mm in width) to fill tissue defects.
In a research report of ABLG performed on 42 patients (average age 34.9 years), the procedure showed potential in suppressing alar retraction, with patient satisfaction evaluation (ROE score) averaging 92.3 points. However, this is a case series study without a comparison control group, and this technique has not yet been established as a standard treatment applicable to all cases.
Measures to compensate for tissue defects and prevent postoperative contraction are considered important factors in achieving better outcomes.
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Summary
In this article, we explained the causes of enlarged alar bases, the limitations of non-surgical treatments, and the indications and risk management for surgical alar reduction. The key points are as follows:
- The ideal alar width is the distance between the eyes (approximately 31–33 mm), and the structure of cartilage and fibrous tissue is the primary cause.
- Because tissue has strong shape memory, non-surgical alar treatments have limitations in physically reducing large widths.
- In alar surgery, precise design such as preserving 2 mm of skin at the alar base prevents unnatural deformities (notching).
- In some cases, improving nasal tip projection alone before reducing alar size can improve the appearance of flared nostrils.
- By using the latest grafting techniques (such as ABLG), it is expected that alar retraction and deformity (contraction) from over-resection can be prevented.
The optimal approach to addressing concerns about the alar base varies depending on each individual's skeletal structure and cartilage condition. This article is intended for general informational purposes and does not replace individual diagnosis. When considering treatment, it is important to consult with a specialized medical institution and receive a diagnosis and explanation suited to your specific condition.
References
- Rohrich R, Savetsky I, Suszynski T, et al. Systematic Surgical Approach to Alar Base Surgery in Rhinoplasty. Plastic & Reconstructive Surgery. 2020 (DOI)
- Davis R, Ostby E. How to Create Ideal Alar Form and Function. Facial Plastic Surgery. 2020 (DOI)
- Pozzi M, Susini P, Murante A, et al. Alar Base Lining Graft: A New Technique to Prevent and Correct Alar Retraction in Primary and Secondary Rhinoplasty. Plastic & Reconstructive Surgery. 2024 (DOI)
- Rohrich R, Adams W. The Boxy Nasal Tip: Classification and Management Based on Alar Cartilage Suturing Techniques. Plastic and Reconstructive Surgery. 2001 (DOI)
- Chen Y, Kim S, Jang Y. Centering a Deviated Nose by Caudal Septal Extension Graft and Unilaterally Extended Spreader Grafts. Annals of Otology, Rhinology & Laryngology. 2020 (DOI)
- Classification of Alar Deformity and Related Treatments (DOI)
- Rohrich R, Durand P, Dayan E. Changing Role of Septal Extension versus Columellar Grafts in Modern Rhinoplasty. Plastic & Reconstructive Surgery. 2020 (DOI)
- Liang Y, Wang X. Application of Diced Autologous Rib Cartilage for Paranasal Augmentation in Cleft Nose. Aesthetic Plastic Surgery. 2021 (DOI)
- Rohrich R, Durand P, Dayan E. Changing Role of Septal Extension versus Columellar Grafts in Modern Rhinoplasty. Plastic & Reconstructive Surgery. 2020 (DOI)
About the Author of This Article
Hiromitsu NakamuraPhysician
Zetith Beauty Clinic Ginza · Osaka · Fukuoka
With a track record of research presentations at domestic and international academic conferences, he is involved in technical guidance and education for Zetith Beauty Clinic as a whole. Specializing in precise rhinoplasty based on anatomical principles, he pursues natural results tailored to each individual's skeletal structure and tissue characteristics.