Alarplasty is a delicate procedure used to narrow wide nostrils. There is a lot of confusion in terminology and treatment methods for this condition. Some ethnicities are more likely to have wider nostrils along with a nasal flare at times. It is more common in African Americans. Some patients find the wide nostrils and/or the flaring of the nostrils to be distracting. The patients might feel self conscious and it can affect their confidence.
Alarplasty involves removing a wedge of tissue from the sides of the nostrils near the junction with the cheek. The base of the wedge is at the level of the alar rims and the pointed apex is near the sides where the nose meets the cheek groove. The amount of excision depends on how wide the nostrils are. Many patients and physicians try to measure the change in mm narrowing on a frontal view. This can be difficult as the size of the wedge removed does not translate exactly into the frontal narrowing distance.
I personally find it better for communicating with the patient to use a scale of small, medium or large change. Majority of the patients require a medium change. It is important to remember that you can always go back and remove more tissue if you feel the nostrils are still wide. However, if you remove too much, you cannot add it back in.
Some surgeons use a suturing technique to pull the side walls medially. It can cause bunching of tissue and is unlikely to be permanent. Others have tried only incisions inside the nostrils out of fear of incisions on the outside. This method cannot achieve a big change. The outside incisions heal well and are well hidden next to the alar groove.
In summary, alarplasty (nostril narrowing) is a good procedure that can be performed in isolation without doing a full rhinoplasty and gives excellent results.