If your nostrils look wide or flared compared with the rest of your nose, you may come across alar base surgery, also called alar reduction, alarplasty or nostril narrowing. It is a small area with a long list of techniques, and the research finds that no single method is the standard.

Key takeaways

  • Alar base surgery narrows the width or flare of the nostrils, either on its own or during rhinoplasty.
  • Techniques include removing small pieces of skin, placing sutures, or flap work. The main trade-off is a possible visible scar at the nostril base.
  • Research shows no agreed gold-standard technique, so which method your surgeon uses, and why, is a fair question.

What is alar base surgery?

The alae are the soft, curved wings of the nostrils, and the alar base is where they meet the cheek. Alar base surgery reduces the width of that base or the outward flare of the nostrils. It can be done during a rhinoplasty or as a separate procedure.

A 2020 systematic review by Gandolfi and colleagues pooled 22 studies covering 1,599 patients. Excision, meaning removal of a small piece of skin, was used in 45.5% of the patients and cinching sutures in 40%. Combined excision and flap techniques made up most of the rest. Nearly half the patients, 795, had nostril surgery at the same time as rhinoplasty. The authors concluded that the techniques give good outcomes and can complement rhinoplasty.

Which technique is used?

Surgeons choose by what they see. In the same review, wedge resection of the alar flare was preferred when flaring was the main issue, and sutures were used more in cases of a wide base with a vertical nostril axis. Surgeons may also combine approaches.

A retrospective study by Kridel and Starr followed 312 patients of one surgeon over 35 years. They describe three techniques: alar flare reduction, sill reduction and V-to-Y advancement. They also say alar base reduction “remains nuanced without consensus as to the gold standard.” So when a clinic tells you its method is the best, the research does not back that claim.

What are the scars and risks?

The main downside is a visible mark where the incision sits at the nostril base. In the Kridel and Starr series, 82 of 312 patients (26.3%) underwent dermabrasion afterward to improve visible incisions. This is one surgeon’s experience, not a general rate, but it shows that scar management is a real part of the plan. The authors note that visible incisions are the most common downside and can be addressed after surgery.

A randomized trial of 90 patients by Kaboodkhani and colleagues compared transalar sutures with external wedge resection. The suture group had significantly less scar formation, shorter operating time and less bleeding, and patient satisfaction on the rhinoplasty outcome questionnaire did not differ significantly between groups. A single trial from one center cannot settle the question, but it shows why asking about the technique matters.

A broader systematic review of rhinoplasty complications by Crosara and colleagues identified alar resection (“alectomy”) as the procedure with the highest complication rate among those analyzed, 4.79% in 174 cases. The authors flagged it as hard to correct if problems occur. That is a reason to ask your surgeon how often they do it, not a reason to assume it will go wrong.

In common practice in Turkey, alar base work added to a rhinoplasty is usually included in the price and does not lengthen the stay. Nose massage and a nostril retainer are both widely used after rhinoplasty there (editorial note, October 2026).

Is perfect nostril symmetry realistic?

No face is perfectly symmetrical. In a Malaysian study, Harun and colleagues measured 30 photographed young Malay adults and found none with an asymmetry index of 0%. When 100 assessors aged 18 to 26 compared the originals with digitally symmetrized versions, they chose the symmetrized face in 91.2% of cases. So symmetry does influence how people judge faces, but it is not attainable in a real face, and a surgeon cannot make the two sides identical. Ask your surgeon how they will handle any difference you have in the left and right nostril, and look at before and after photos of similar cases.

Questions to ask your surgeon

  • Do you recommend alar base surgery for my nose, or would other changes to the tip or bridge address what bothers me?
  • Which technique do you use, and why that one for me?
  • Where will the incisions sit, and can I see healed photos at several months?
  • What is your plan if the scar is visible?
  • How would the surgery affect the shape of my nostrils from the front and from below?
  • Will I need a nostril retainer afterward, and for how long?
  • If I have a follow-up question after traveling home, who answers?

Alar base work is often part of a broader plan, so it helps to read about tip refinement, rhinoplasty on different nose types and how to approach your first consultation. If the area that bothers you is the skin between the nose and the upper lip, see our guide to lip lift types.

Sources

All pages were opened and checked in October 2026.