Under normal circumstances, the outermost edge of the nostrils should not extend beyond the vertical line of the inner canthus (inner corner of the eye). If it does, it indicates enlarged alae. Wide alae make the nostrils appear large. Even if the nose itself is not low, very wide alae can make it appear low, giving the face a somewhat blunt and lackluster appearance.For low noses with slightly wide alae, rhinoplasty alone can achieve alar reduction. However, individuals with very wide alae require dedicated alarplasty to reduce the overall nasal size and achieve a more refined, mature appearance. The following surgical principles must be followed for alarplasty.
1. Prior to surgery, routine coagulation function tests must be conducted. For deformities caused by underlying diseases, the disease should be treated first to eliminate the cause. Local nasal infections must also be treated beforehand.
2. Surgery is best performed after the patient reaches adulthood. Repairing too early risks the nose becoming deformed again after facial development.
3. In cases of severe nasal collapse with upward retraction of skin and soft tissue, staged surgery is essential. First, dissect the nasal structure and reposition it normally before implanting the filler material.
4. Strict sterilization is mandatory during surgery. Infection may cause the filler material to necrotize and expel.
V. Before implanting the filler, careful attention must be paid to the separation layers, cavity size, and symmetry. The resulting cavity should be suitable for the filler placement—neither too tight nor too loose.
VI. Based on the shape and size of the depressed areas (such as the nasal bridge), an appropriate filler is implanted. The wound is then sutured, and the external nasal shape is stabilized. Postoperative penicillin injections are administered to prevent infection.
Indications for Nasal Wing Reduction Surgery
1. Thick, wide, or drooping nasal wings;
2. Excessively flared wings causing unsightly large nostrils.
The following techniques may elevate and correct deformities:
(1) Marginal resection;
(2) Reshaping the lateral crus of the alar cartilage and the lower margin of the septal cartilage;
(3) Partial resection of the alar lining;
(4) Alar base reduction;
(5) Thickened alar base reduction is often a congenital deformity, which can easily create the illusion of a drooping columella.