Alar Reduction Surgery: Internal vs. External, and Scarring

Nostril wings too wide or nostrils too large, so you are always being teased about it? What are the golden proportions of a refined, petite Korean-style nose tip? Do massage or injectables shrink the nostril wings? Am I actually a good candidate for alar reduction? How do the internal and external incision approaches differ, and will there be scarring? This article answers your questions about alar reduction to help you achieve a refined, beautiful nose.

What Are the Ideal Nostril Wing Proportions and Nostril Shape?

Alar width equals the distance between the eyes

Divide the face into three equal parts so that the width of the nose takes up about 1/3 of the entire face; using the inner corners of the eyes as the reference, the alar width should equal the distance between the eyes.

Teardrop-shaped nostrils

The distance from the nose tip to the upper edge of the nostril to the distance from the upper edge of the nostril to the alar base should be 2:1, which gives the nostril a teardrop shape that looks natural and harmonious.

Does the Nose Have a Golden Ratio Too? How to Create the Perfect Nose Shape

Debunking Alar Reduction Myths: Do Massage and Injectables Work?

1. Massage for alar reduction: Ineffective!

The “alar reduction massage” that went viral on Xiaohongshu (RedNote) involves repeatedly pinching the base of the nostril wings between the index finger and thumb and lifting upward along the bridge of the nose, in the hope that lymphatic massage will fix wide nostril wings. In fact, alar reduction massage can only help facial circulation and reduce puffiness, and it offers no substantive help in reshaping or changing the nostril wings.

2. Botox for alar reduction: Not very effective!

Botox alar reduction works mainly by injecting Botox into the dilator naris muscle of the nostril wings and the levator labii superioris alaeque nasi muscles on both sides, which weakens the muscles and shrinks the nostrils, improving flared nostril wings. However, if the cause is not muscular but simply thick, bulky nostril wings, this treatment is not suitable.

3. Hyaluronic acid filler for alar reduction: Limited effect!

Injecting some hyaluronic acid filler into the nasal tip and columella adds volume there and stretches the nostril wings on both sides, so the wings and nostrils look smaller and exposed nostrils are concealed! However, if the filler is too soft, it easily spreads outward over time, making the nose wider with each injection, so choosing the right filler texture and formulation is very important.

4. Thread lift for alar reduction: Limited effect!

Absorbable threads are placed inside the nose. Depending on the angle at which the doctor inserts them, they push the nose tip outward and forward, which also pulls the flattened nostril wings forward and gives the visual effect of smaller nostril wings. However, threads do not provide as much support as an implant, so they cannot significantly change the appearance of the nostril wings, and they are also not suitable for people with thin nasal skin or a naturally flat, low nose.

What Is Thread-Lift Rhinoplasty? Pros, Cons, and Who Is a Good Candidate

All of the non-surgical alar reduction methods above can only make the nostril wings look smaller “visually,” cannot fundamentally fix oversized nostril wings, and are suitable only for a limited range of candidates, and none of them can significantly change the appearance of the nostril wings or nasal tip. That is why alar reduction surgery is the most effective and fundamental way to correct wide or large nostril wings.

How Do You Know If You Are a Good Candidate for Alar Reduction?

Ideal candidates for alar reduction

Simple self-tests for alar reduction

Method 1: Cotton swab test (not suitable if your nose is already well projected)

If you feel that propping up the nose tip with rhinoplasty would already give the nostril wings your ideal look, there is no need to add alar reduction surgery. Otherwise, you may need to pair it with surgery to draw the nostril wings inward.

Method 2: Finger test

This simulates the effect of an external alar excision. If you find that resting your fingers lightly is not enough and the wings need to be drawn in a bit more, you may also need to add surgery to draw the nostril wings inward.

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Internal Approach Alar Reduction Surgery

Surgical method

Internal-approach alar reduction is performed along the lower edge of the nostril wings, on the inner rim of the nostrils. A portion of tissue is removed and sutures are used to shorten the distance between the two nostril wings, adjusting the width of the wings and the size of the nostrils to make the wings smaller.

Incision location

The incisions are inside the nostrils, so there is no obvious external scar after surgery.

Suitable candidates

Those with mild alar flaring

Those with an overly wide nasal base

External Approach Alar Reduction Surgery

Surgical method

An incision is made along the outer edge of the nostril wing, a portion of tissue is removed, and the incision is sutured. By reducing the volume of the nostril wings, this corrects excessively flared wings, reduces their visual bulk and fullness, and draws both sides slightly inward so that the nose looks smaller overall.

Incision location

The incision is on the outer skin at the base of the nostril wing and may leave a small external scar after surgery.

Suitable candidates

Those with moderate to severe alar flaring

Those who want to change the shape of their nostrils

Internal vs. External Alar Reduction