Does the Shape of Alar Reduction Differ by Incision Range? — The Difference Between an Incision Below and One Extending to the Side

01

What was the question?

Looking around several clinics, the asker found the method for reducing the nostrils explained in two ways.

• Method 1 — incision only below the nostril. Understood that trimming and rejoining only below gathers flesh downward, making a rounder-looking nostril
• Method 2 — extending the incision range about 2–3mm from below to the side. Understood that pulling below and to the side together makes a slimmer, more elongated nostril

The asker's own nostrils were on the round side, so they wanted the slim look of method 2 — but if there was actually little difference, they wondered whether method 1 with its shorter incision line was better.

02

What kind of concept is incising only below?

It is close to a method that reduces the floor area between the nostril and the columella (nasal pillar) to narrow the overall nasal width. It is considered when the floor width is broad rather than when the ala itself is voluminous, and the range of change possible when only excising below can be limited depending on structure.

03

How is the method extending the incision to the side different?

Method 2 is a relatively widely used approach. It has the advantage of reducing the volume of the ala itself while making the nose look gathered inward. Still, as the incision extends to the side, the possibility of a scar remaining on the outside must be considered.

Organizing the two methods and the remaining options looks like this.

Which of these methods is appropriate is most accurate when judged by direct examination of current nostril size, skin thickness, and overall nasal proportions.

04

How are they combined in practice? — A case combined with non-incision alar reduction

The case presented together had tip cartilage splayed left and right, so viewed from below the nostrils looked spread out lying sideways. Wanting a natural impression, tip cartilage tying tidied the tip without strain and supplemented the height; what is looked at in tip correction can be seen in more detail in the nasal tip surgery guide.

The points confirmed together in this case were as follows.

• Correction of accompanying deviated septum — from the front the bridge was low and unremarkable, but there was a mild deviated septum with the septum tilted to one side. A bend that is hardly visible when the bridge is low often becomes more pronounced once the bridge is raised, so correcting it together during surgery is necessary.
• Material selection — 4mm silicone of a moderate height was used on the bridge for balance, and because the nasal structure was small and low, septal cartilage alone provided insufficient support, so ear cartilage was used together.
• Non-incision alar reduction combined — the nostrils were spread wide left and right, so a non-incision method was combined to narrow nasal width without straining expression changes.

After surgery, the reduced nasal width from the front confirmed an overall tidied impression. The actual change can be seen in the before-and-after photos.

05

Should scar worries make you hesitate on alar reduction?

Many think a bulbous nose necessarily requires alar reduction, but in fact quite a few cases improve sufficiently with tip cartilage tying alone.

Some worry that alar reduction will look unnatural when smiling or leave a scar — but not every case requires an incision method, and a non-incision option with less scar burden can also be chosen. Even with an incision method, depending on the surgical technique and suture position, many cases recover without the scar being overly noticeable, so there is no need to worry beyond what is necessary.

06

Summary — "what is being reduced" comes before incision length

In alar reduction, the incision range is less an option for choosing the resulting shape than a result that differs depending on whether what you want to reduce is nasal width or alar volume. With options extending to suture methods, non-incision methods, and pulling up drooping alae, the order is: before picking the side with the shorter incision line, first confirm which method fits your nostril size, skin thickness, and overall nasal proportions.

If you wonder which method fits your nostrils, it can be checked directly in a 1:1 video consultation.