Follow the accompanying figures and text to perform alar base resections (1,2).

The site of incisions and the amount, degree, and geometry of alar reductions depend on a host of anatomic variations predetermined before and during surgery. Although the surgeon’s aesthetic judgment will ultimately determine the site and degree of resection, a more precise surgical approach may be determined if several anatomic guidelines are assessed and integrated. Conservatism is mandatory to avoid over-reduction and asymmetry, conditions that are difficult to correct satisfactorily.

As the need for reduction increases, both the incision and excision become more extensive. Alar reduction is a compromise operation, in which greater reductions exact the penalty of a larger scar. The surgeon must balance this compromise with experienced aesthetic judgment and proven scar-camouflage techniques.

Skin sutures placed across the alar-facial junction often lead to permanent suture marks. Effective camouflage at the alar-facial junction may be facilitated by positioning incisions 1 mm to 2 mm above the alar-facial junction. Skin closure can he performed with a cyanoacrylate adhesive (octyl-2-cyanoacrylate, Dermabond; Ethicon, Somerville, NJ, U.S.A.).