Alar Base Surgery

  • Bülent Koç
  • Nuray Bayar Muluk
  • Ji Yun Choi


The concept of narrowing the nasal alar base is external wedge excision technique in correction of the excess alar flare while hiding the incision in the alar-facial groove. Weir first described the alar base resection in 1892. In 1931, Joseph and Milstein described narrowing the nostril base and vestibular floor. In 2007, Foda described the combined alar base excision technique for nasal base narrowing in cases of a wide alar base with excessive nasal flare. The alar base plays an important role in the overall appearance and balance of the nose. The alar base, however, is not often evaluated independently during nasal examinations at the time of surgery. As a result, it is one of the most frequently encountered imperfections during secondary rhinoplasty. Deformities of the nasal alar base are a common finding in secondary rhinoplasty. Although some are recognized easily, many deformities are subtle and will be identified only during a detailed examination by the surgeon. A primary deformity that does not occur at the beginning or develops as a secondary deformity, for example, excessive flaring, may develop after reconstruction of the tip projection. When narrowing the alar base, a limited resection is preferred to a comprehensive, since resecting additional alar tissue is simple while having to reconstruct a stenotic alar is a complicated process. In this chapter, alar base surgery is discussed in all aspects.


Alar base Surgery Rhinoplasty Deformity Narrowing 


  1. 1.
    Weir RF. On restoring noses without scarring the face. N Y Med J. 1892;56:449–54.Google Scholar
  2. 2.
    Joseph J. Nasenplastik und sostige Gesichtsplastik nebst einem Anhang über Mamaplastik. Leipzig: Curt Koitzsch; 1931. p. 110–3.Google Scholar
  3. 3.
    Foda HMT. Nasal base narrowing: the combined alar base excision technique. Arch Facial Plast Surg. 2007;9:30–4.CrossRefGoogle Scholar
  4. 4.
    Bloom JD, Constantinides M. Alar base modification. Rhinoplasty archive. Accessed 3 June 2015.
  5. 5.
    Willis AE 2nd, Costa LE 2nd. Surgical management of the alar base. Atlas Oral Maxillofac Surg Clin North Am. 1995;3(2):65–77.CrossRefGoogle Scholar
  6. 6.
    Guyuron B. Alar rim deformities. Plast Reconstr Surg. 2001;107(3):856–63.CrossRefGoogle Scholar
  7. 7.
    Rohrich RJ, Hoxworth RE, Thornton JF, Pessa JE. The pyriform ligament. Plast Reconstr Surg. 2008;121:277–81.CrossRefGoogle Scholar
  8. 8.
    Larrabee WF Jr. Facial analysis for rhinoplasty. Otolaryngol Clin North Am. 1987;20(4):653–74.PubMedGoogle Scholar
  9. 9.
    Farkas LG, Hreczko TA, Deutsch CK. Objective assessment of standard nostril types—a morphometric study. Ann Plast Surg. 1983;11(5):381–9.CrossRefGoogle Scholar
  10. 10.
    Crumley RL. Aesthetics and surgery of the nasal base. Facial Plast Surg. 1988;5(2):135–42.CrossRefGoogle Scholar
  11. 11.
    Guyuron B, Behmand RA. Alar base abnormalities. Classification and correction. Clin Plast Surg. 1996;23(2):263–70.PubMedGoogle Scholar
  12. 12.
    Sim RS, Smith JD, Chan AS. Comparison of the aesthetic facial proportions of southern Chinese and white women. Arch Facial Plast Surg. 2000;2(2):113–20.CrossRefGoogle Scholar
  13. 13.
    Vartanian JA. Basic closed rhinoplasty treatment & management. Granick MS (Chief Editor). Accessed 3 June 2015.
  14. 14.
    Bennett GH, Lessow A, Song P, Constantinides M. The long-term effects of alar base reduction. Arch Facial Plast Surg. 2005;7(2):94–7.CrossRefGoogle Scholar
  15. 15.
    Adamson PA. Alar base reduction. Arch Facial Plast Surg. 2005;7(2):98.CrossRefGoogle Scholar
  16. 16.
    Watanabe K. New ideas to improve the shape of the alar of the oriental nose. Aesthetic Plast Surg. 1994;18:337–44.CrossRefGoogle Scholar
  17. 17.
    Adamson PA, Oakley S, Tropper GJ, McGraw BL. Analysis of alar base narrowing. Am J Cosmet Surg. 1990;7:239–43.CrossRefGoogle Scholar
  18. 18.
    Toriumi DM, Becker DG. Rhinoplasty dissection manual. Philadelphia, PA: Pa Lippincott Williams & Wilkins; 1999. p. 113–5.Google Scholar
  19. 19.
    McKinney PW, Mossie RD, Bailey MH. Calibrated alar base excision: a 20-year experience. Aesthetic Plast Surg. 1988;12:71–5.CrossRefGoogle Scholar
  20. 20.
    Gilbert SE. Alar reductions in rhinoplasty. Arch Otolaryngol-Head Neck Surg. 1996;122:781–4.CrossRefGoogle Scholar
  21. 21.
    Becker DG, Weinberger MS, Greene BA, Tardy ME. Clinical study of alar anatomy and surgery of the alar base. Arch Otolaryngol-Head Neck Surg. 1997;123:789–95.CrossRefGoogle Scholar
  22. 22.
    Constantian MB. An alternate strategy for reducing the large nasal base. Plast Reconstr Surg. 1989;83:41–52.CrossRefGoogle Scholar
  23. 23.
    Jackson IT, Moos KF, Sharpe DT. Total surgical management of Binder’s syndrome. Ann Plast Surg. 1981;7:25–34.CrossRefGoogle Scholar
  24. 24.
    Santana PSM. Treatment of the Negroid nose without nasal alar excision: a personal technique. Ann Plast Surg. 1991;27:498–506.CrossRefGoogle Scholar
  25. 25.
    Tebbetts JB. Primary rhinoplasty: a new approach to the logic and the techniques. St. Louis, MO: Mosby; 1998.Google Scholar
  26. 26.
    Warner JP, Chauhan N, Adamson PA. Alar soft tissue techniques in rhinoplasty: algorithmic approach, quantifiable guidelines, and scar outcomes from a single surgeon experience. Arch Facial Plast Surg. 2010;12(3):149–58.CrossRefGoogle Scholar
  27. 27.
    Kridel RW, Castellano RD. A simplified approach to alar base reduction: a review of 124 patients over 20 years. Arch Facial Plast Surg. 2005;7(2):81–93.CrossRefGoogle Scholar
  28. 28.
    Silver WE, Sajjadian A. Nasal base surgery. Otolaryngol Clin North Am. 1999;32:653–68.CrossRefGoogle Scholar
  29. 29.
    Ismail AS. Nasal base narrowing: the alar flap advancement technique. Otolaryngol Head Neck Surg. 2011;144(1):48–52. Scholar
  30. 30.
    Adamson PA, Smith O, Tropper GJ, et al. Analysis of alar base narrowing. Am J Cosmet Surg. 1990;7:239–43.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Bülent Koç
    • 1
  • Nuray Bayar Muluk
    • 2
  • Ji Yun Choi
    • 3
  1. 1.Bülent Koç Rhinoplasty CenterİstanbulTurkey
  2. 2.Department of Otorhinolaryngology, Medical FacultyKırıkkale UniversityKırıkkaleTurkey
  3. 3.Department of OtorhinolaryngologyChosun University Hospital and College of MedicineSeoulSouth Korea

Personalised recommendations