The short answers

What it changes: Nostril base width and alar flare onlyIt does not narrow the bony bridge, refine the tip or improve breathing.
Two main excisions: Nostril sill, alar wedge, or both combinedSill excision reduces interalar width and nostril size. Wedge excision reduces flare.
When flare counts as significant: More than about 2 mm lateral to a vertical line from the medial canthusWidth and flare are independent measurements, and each has its own excision.
Typical measured change: Interalar to intercanthal ratio 1.10 before surgery, 1.02 afterMean values in a 52-patient combined sill and wedge series at 18 months.
Scar outcomes: 96.2 percent rated their scar unnoticeable in that seriesIn a separate 124-patient series, around 25 percent had dermabrasion for a noticeable scar.
Sun protection: High SPF sunscreen for at least 6 monthsHealing nasal skin discolours easily, and some instructions advise 12 months.

A nose can look wide for several reasons: a broad bony bridge, an under-projected tip, or a genuinely wide base. Alar base reduction addresses only the last, so a wide nose is not automatically a base problem.

Survey work in African American rhinoplasty, reported in Seminars in Plastic Surgery, found patients commonly wanted a narrower dorsum, better tip definition and a reduced interalar distance, while keeping slight alar flare. That preference for refinement shapes ethnic rhinoplasty.

What alar base reduction changes

It can reduce nostril base width, outward alar flare, and the size of a large nostril opening. Mild asymmetry can improve, though rarely to a true match.

It cannot narrow the bony bridge, which needs osteotomies, or refine a bulbous or under-projected tip, the work of tip plasty.

It does not improve nasal breathing. Because it makes the external opening slightly smaller, it is not used to treat obstruction.

How width and flare are judged

Alar base width is conventionally compared with the intercanthal distance, between the inner corners of the eyes. StatPearls, the clinical reference on the NCBI Bookshelf, describes the norm as varying with nasal morphology.

A narrow, leptorrhine nose tends to match the intercanthal distance.
A broad, platyrrhine nose more often matches the wider intercaruncular distance.
Mesorrhine noses sit between the two.

Those norms describe populations, not surgical targets. Over-narrowing can look out of proportion with the cheeks, lips and midface.

Flare is a separate measurement from width. It is generally regarded as significant beyond roughly 2 mm lateral to a vertical line dropped from the medial canthus.

Sill excision, wedge excision, and why base work comes last

Nostril sill excision. A segment is removed from the nostril floor where it meets the lip, reducing interalar distance and nostril size.
Alar wedge excision, or modified Weir excision. A wedge is taken from the alar rim through the crease. It reduces the outward bow of the ala more than the base width.
Combined sill and wedge excision. Used where both width and flare are present.

Base work usually comes last, because tip projection changes how wide the base looks. Increasing projection narrows the alae. Reducing it, or shortening the nose, widens the base and increases flare.

Measuring before the tip is settled risks removing the wrong amount. The decision is often made during surgery, and some patients who expected narrowing turn out not to need it.

Where a base has been over-narrowed, notched or left asymmetric, correction is revision surgery, harder than the original because excised tissue cannot be put back.

The scar, and what the published series show

The incisions sit at the alar crease, at the nostril sill, or at both. Those are the places on the nose where a scar shows least. They are still real scars, they are permanent, and they are the trade this operation asks for.

In a retrospective series of 52 Asian patients, published in the Journal of Craniofacial Surgery, the mean ratio of interalar to intercanthal distance fell from 1.10 to 1.02. Mean follow up was 18 months.

In that group, 96.2 percent rated their scar unnoticeable on a visual analogue scale, and 94.2 percent scored good on the Stony Brook Scar Evaluation Scale. No alar deformities were reported.

A single-surgeon series does not automatically generalise. A separate single-surgeon series of 124 patients spans 20 years of practice, with mixed excisions. Mean age was 30.4 years and mean follow up 2 years.

In that group, around 25 percent later had dermabrasion for a noticeable incision scar. That is the figure to weigh against the averages above.

Anyone with a personal or family history of hypertrophic or keloid scarring should raise it before surgery. It changes the balance of risk and benefit more than for most operations.

Recovery, and how long the scar takes to fade

The narrowing is visible almost immediately, because it comes from tissue removal rather than swelling settling. The scar is the part that takes months.

Days 5 to 8External sutures come out, at the interval given by the American Academy of Facial Plastic and Reconstructive Surgery. Dressings and splints follow at 5 to 10 days.
Several monthsThe scar commonly stays pink or firm before it fades. High SPF sunscreen is commonly advised for at least six months, and some instructions say twelve.
Up to a yearWhere base work is one step of a full rhinoplasty, the nasal contour may keep refining around it. The day-by-day timeline covers that longer course.

Before you agree to anything

A base excision is not straightforwardly reversible, because excised tissue cannot be put back. Who holds the scalpel matters more than the technique named in a quote. Ask how much they propose to take, and how they decide. Our doctors answer that in writing.

Questions to ask a surgeon

Take these to a consultation. The consultation checklist is built to be printed and written on, and our doctors will answer questions sent through the site before you travel.

Is my nose wide at the base, or is it the bony bridge and the tip, and can you show me the difference on my own photographs?
Will you decide how much to remove before surgery, or after the dorsum and tip are done?
Sill excision, wedge excision or both, and what does each one do to my nostril shape?
Where exactly will the incisions sit, and what should the scar look like at six months and at a year?
What is the plan if the scar thickens, and would dermabrasion be done there or back at home?
If the base ends up over-narrowed or notched, who pays for the revision and where would it be done?

Sources

Every source below was opened and checked. We link to health authorities, peer-reviewed journals and professional bodies, and to nothing else.

Correcting wide alar base and flare with combined sill and alar excisionJournal of Craniofacial Surgery, via PubMedTechnique and outcomes for alar base narrowing.
Rhinoplasty: the African American patientSeminars in Plastic Surgery, via PubMed CentralPeer-reviewed discussion of anatomical differences and identity-preserving technique.
RhinoplastyStatPearls, NCBI Bookshelf (National Library of Medicine)Peer-reviewed clinical reference covering anatomy, technique selection and complications.
Nasal cosmetic surgeryAmerican Academy of Facial Plastic and Reconstructive SurgerySpecialist society overview of aesthetic nasal surgery.