Alar rim surgery, also known as alar base reduction, is a specialized procedure that enhances the shape and balance of the nostrils, resulting in a more harmonious facial appearance. Many patients seek this procedure to address wide or flaring nostrils, asymmetry, or disproportion between the nose and other facial features. Beyond aesthetic goals, some pursue alar rim surgery to improve nasal function or boost self-confidence when the nose feels out of proportion.
With precise techniques tailored to each individual, this surgery can create subtle yet transformative results that complement your natural features while addressing the specific concerns that bring you to consider the procedure.
Alar rim surgery is the name plastic surgeons use when they are talking about changing the shape of a patient’s nostrils. Most lay people call it nostril surgery. Dr. Freeman recommends that alar rim surgery not be done at the same time as a rhinoplasty or a revision rhinoplasty. There are many reasons for this, but the most important one is that when a rhinoplasty is performed to change the shape of the tip cartilage, that surgery is going to change the shape of the nostril in a non-quantifiable way.
If the surgeon performed alar rim surgery at the same time as rhinoplasty, they would be operating on a nostril whose shape would change after the rhinoplasty, which is not a good idea. Other reasons are that the incision for alar rim surgery is visible, and the swelling from the rhinoplasty would make it heal with a more visible scar. In addition, alar rim surgery is almost always done under local anesthesia following a nerve block and has minimal swelling and bruising; in general, it is a patient-friendly procedure. Another point is that in Dr. Freeman’s experience of over 30 years, only about 6-8% of rhinoplasty patients decide they want alar rim surgery, which means many surgeons are overperforming this procedure and, conversely, patients are overpaying for a procedure they may not need.
There are two types of procedures done during alar rim surgery.
Alar rim surgery is typically performed under local anesthesia with a nerve block, which numbs the nostrils and surrounding areas while keeping you comfortable and alert. This approach avoids the risks and recovery time associated with general anesthesia, and most patients experience minimal discomfort during the procedure. Sedation is rarely needed, making the surgery a patient-friendly option.
The procedure begins with carefully placed incisions along the base of the nostrils. For a Weir procedure, the incisions are made at the outer edges of the nostrils to reduce flaring. In a nasal sill procedure, the incisions are placed at the nostril base to adjust width or shape. These incisions are designed to be as discreet as possible, blending with the natural creases of the nostrils.
Once the incisions are made, excess tissue – skin, muscle, or cartilage – is carefully removed or reshaped to achieve the desired nostril contour. In a Weir procedure, the focus is on narrowing and reducing outward flare, while in a nasal sill procedure, tissue is adjusted to support improved symmetry and balance with the nasal tip or augmentation. Precision is key to maintaining natural proportions.
After the necessary adjustments, the incisions are closed with fine, precise sutures to minimize visible scarring. Suturing is done meticulously to maintain nostril shape, prevent distortion, and support proper healing. The placement of sutures ensures the nostrils retain a natural curve and symmetry once swelling subsides.
Throughout the surgery, Dr. Freeman continuously checks for symmetry and balance between both nostrils. Adjustments are made gradually to ensure the final shape complements the overall facial structure. This attention to detail helps achieve subtle yet transformative results that enhance both aesthetics and proportion.
Immediately after alar rim surgery, patients can expect mild swelling and tenderness around the nostrils. Pain is usually minimal and can be managed with over-the-counter medications. During this period, it is important to rest and keep the head elevated to reduce swelling. Any dressings or tape applied to the nostrils help support the new shape and control minor bleeding.
During the first week, most swelling and bruising begin to subside, and sutures, if not dissolvable, are typically removed. Patients are advised to avoid strenuous activity, bending, or heavy lifting to prevent stress on the healing tissues. Gentle cleaning of the nostrils, as instructed by the surgeon, promotes optimal healing without disturbing the surgical site.
By the second and third weeks, swelling continues to decrease, and the nostrils start to settle into their refined shape. Many patients feel comfortable resuming normal daily activities, though results may still depend on individual healing patterns. Light exercise may be reintroduced gradually under the surgeon’s guidance.
Most visible signs of surgery, including bruising and puffiness, are significantly reduced by this stage. The nostrils begin to take on their final contour, and patients often see a noticeable improvement in symmetry and proportion. The length of the nostril may appear subtly shorter or more balanced, reflecting the precision of the surgery.
Final results continue to refine over several months as residual swelling resolves. The incision lines fade, and the nostrils achieve their permanent shape. Patients typically report satisfaction with the natural appearance and improved balance of their nose, completing the recovery process.
Alar rim surgery is ideal for patients who are concerned about the size or shape of their nostrils and want to achieve better balance with the rest of their facial features. Candidates may wish to remove excess tissue that causes flaring or asymmetry, or to subtly increase definition and refinement in the nostril contour. Patients with naturally wide nostrils, nostril asymmetry, or changes after previous nasal surgery often benefit from this procedure, as it allows for precise, individualized adjustments that enhance both aesthetics and proportion.
When considering an alar rim surgery, Charlotte residents can trust Only Faces to deliver precise, natural-looking results that enhance facial harmony. In many cases, the best outcome comes from a combination of procedures tailored to each patient’s needs, ensuring the nose complements the overall facial structure. Even subtle adjustments, such as refining a flat or wide nostril, can create a significant improvement in balance and symmetry. During your consultation, we will discuss the approximate changes you can expect and provide a clear plan for achieving them.
Alar rim surgery primarily focuses on reshaping the nostrils and soft tissue around the base of the nose rather than modifying the underlying cartilage or tip. While minor adjustments to the surrounding structures may be made for symmetry, this procedure does not typically include full cartilage grafting or major nasal tip refinement, making it less invasive and easier to recover from.
Most patients experience minimal discomfort during and after alar rim surgery. The procedure is usually performed under local anesthesia with a nerve block, so pain during surgery is effectively managed. Postoperative soreness or tightness around the nostrils is mild and can typically be controlled with over-the-counter medications. Swelling and tenderness gradually subside within the first week.
Yes, alar rim surgery can be performed after a revision rhinoplasty, but it requires careful planning. Previous procedures that altered the nasal bones, deviated septum, nasal bridge, or columella may affect how the nostrils respond to additional surgery. In some cases, alar rim adjustments are best done separately rather than at the same time as an open rhinoplasty, to ensure the nostrils heal properly and retain their natural shape. The incisions are closed carefully to complete the procedure with minimal visible scarring.
