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Correction of the Wide Nasal Base
The Problem
Wide alar base: aesthetically over-large sill and/or excess alar curve.
The Background
The widened alar base is a common anatomical variation that is often addressed in the routine rhinoplasty to address aesthetic changes for improving the overall appearance of the nose. These are basically involved with two distinct anatomical structures that are addressed surgically to reduce the widened nasal base. They are the nostril sill and the nasal alar rim. These structures can be addressed individually or in combination. One can remove a wedge from the alar rim at the attachment to the nasal alar groove or remove a triangular section of the sill with the apex inside the nostril. The outer incision of the triangular resection of the sill is placed in a crease when the alar is slightly pushed inward with the apex of the triangle inside the nostril. Also, a combined resection of the alar rim and the sill can be performed at the same time, depending on the desired aesthetic changes. The amount of resection of each is dependent on the correction desired.
Alar
Flaring or lateral extension of the alar extending significantly beyond the alar facial groove or beyond a straight line drawn inferiorly from the medial canthus. This may be related to the alar rim being too long or the sill too wide. The aesthetic position is that the alar rim should be just inside the alar groove. An exception is in some ethnic faces, such as the African nose. In that case the alar may extend slightly beyond this facial groove line and still be aesthetically pleasing.
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