Background: Numerous alar base modification techniques
have been reported in the literature. Specifically, three different  techniques were described to manage cases with alar flaring in addition to a wide nasal base. Tissue excision from the alar
lobule as well as from the inside of the nostril is executed to
decrease the alar flaring and the nostril width, respectively.
Further techniques include cinching sutures that help advance
the alae together and flap advancement.
The aim of this study is to emphasize the aesthetic impact
of the basal nasal view and to reach a maximum aesthetic
result concerning nasal alar flare.
Patients and Methods: A prospective study was conducted
on 25 patients. All patients had alar flaring seeking alar
reduction, either alone or as a part of a full rhinoplasty. During
rhinoplasty, alar base reduction was done at the end of rhinoplasty
surgery, after the closure of all rhinoplasty incisions
and after osteotomy was done. A caliper was used to sharply
stab the skin from the lateral limb to the desired sill crease
to determine the medial limb of the triangular wedge to be
excised. The base of the triangular wedge was directed downward
and the apex was directed intra-nasally.
Results: The current study showed that the internal alar
resection significantly decrease the alar flare; as the inter-alar
distance ranged between (35-43mm), Mean±SD (39.2±2.3)
before surgery and becomes between (31-37mm) Mean±SD
(34.8±2.0) after the surgery, with a significant improvement
(p-value: <0.001).
Conclusion: Internal alar resection effectively reduced
the alar flare, and improved the nostril shape and width. This
technique was also useful to retain symmetry of nostril shape,
hide the scars internally in the nose, avoid the injury of the
lateral nasal artery, preserve the natural curvature of alar rim
and avoid detachment of the alar foot plate. This technique
can effectually be applied to all patients with alar flare
reduction