I would like to share a part of my story to raise awareness about a procedure called alar base reduction. I’m not sharing to scare anyone or to discourage others from having it done, but to shed light on the potential consequences when it goes wrong.
My intention is to raise awareness, encourage proper education, and open honest dialogue between patients and their surgeons. Many people have an alar base reduction with a successful outcome, however, there are also plenty of people in revision groups desperate to “reverse” this procedure. When done too aggressively, unnecessarily, or on a patient who isn’t a good candidate, the result can be truly devastating.
I had my primary septorhinoplasty with Dr. Mehmet Erdil in Istanbul in July 2024.
Before surgery, my nostrils flared naturally and breathing was effortless and satisfying. I never felt my nostrils and never experienced any resistance when breathing.
After the alar base reduction, everything changed.
Tissue was excised at the nostril base, removing natural curvature and making my alae too short. This created aesthetic and functional issues. The alae play a crucial role in supporting the nostrils and maintaining unobstructed airflow. Because the curvature was removed at the base, my nostrils healed very narrow, and my external nostril openings do not align properly with my internal nasal airways.
My nostrils can no longer flare outward and round out to the sides when I inhale like they used to. The only direction that they can stretch is upward, which causes the rims to notch and create awful, even more distorted nostrils.
The resistance when the nostrils try to open but physically cannot is mentally exhausting. FEELING your alae being too short is absolute torture. There is constant tightness, tension, and aching pain. I experience air hunger. There are times when I feel close to a panic attack due to the inability to flare my nostrils and breathe well; my nostrils then begin to frantically and repeatedly try to open, like the gills of a fish out of water trying to pull in air. It becomes so overwhelming and panic-inducing. Other times, the resistance is so maddening that I feel the urge to tear my nostrils apart or slice them open at the base just to relieve the tension. I would not wish this on anyone.
Beyond how awful these nostrils feel, the aesthetic damage is just as devastating.
The nostrils now have a strange, unnatural shape due to the loss of alar curvature, constant strain and alar retraction. They have straight lines and sharp corners and look very obviously operated on. The base is narrow and tight. My alar facial grooves (creases) have been reduced. The right ala, which was already shorter and had a less prominent groove before surgery, now looks especially deformed.
There are harsh demarcation lines where the incisions were placed, and it looks like my nostrils are growing straight out of my cheeks. The scarring is awful.
The alar base reduction is irreversible.
I want to mention that I have other issues affecting both my breathing and the appearance of my nostrils. I’m having a revision soon, and I’m hopeful that once the tip is derotated and the bridge is built back up, it may give me a bit more nostril width at least on the left side. Unfortunately, even though my revision surgeon is a reconstructive surgeon capable of rebuilding an entire nose or an ear out of almost nothing, he has still told me that he doesn’t think that he’ll be able to improve my nostril situation. In fact, I have been turned away by other surgeons because they were concerned that the result would not be satisfactory or that they could potentially make things worse.
At this point, I will need to see how things heal after my main revision to rebuild the nose before deciding on any further steps for an additional procedure to reconstruct my right nostril. I am continuing to research options such as wedge composite graft (where skin and cartilage are taken from the ear and added at the base of the nose), as well as skin flaps.
If you are considering rhinoplasty, please take the time to really understand every step of the procedure, especially alar base reduction, and make sure that you and your surgeon are completely on the same page.
Find a surgeon who respects your wishes and your natural anatomy, and also takes a conservative approach. Once tissue is removed, it cannot simply be restored.
It’s also important to know that an alar base reduction does not have to be done at the same time as your main rhinoplasty. I’ve personally seen examples of patients who started with large nostrils and never had an alar base reduction, yet still ended up with very small nostrils afterward. If there is any uncertainty, it can be done later as a separate minor procedure.
Wishing everyone the best of luck on their journey.