A distinct minority of Asian patients undergoing rhinoplasty are sastisfactory candidates for reduction in the width of the nasal base or flare at the nostrils. Most such patients tend to be of southeast Asian or Filipino descent. The procedure may be used as an adjunct to either augmentation or reduction rhinoplasty.
The procedure works best when the lobule of the nose is normal in width since alar excision in the presence of a wide lobule with poor tip projection rather than simply wide alae can worsen appearance by making the nose appear aesthetically too square. Since the Asian nose has thicker skin and more fatty tissue just below, the operation is more extensive than when used in European patients and the improvement is generally less than dramatic.
In most cases, a variable full-thickness wedge of tissue is removed along the outer rim of each nostril and the resulting wounds then sutured. Some patients may undergo the operation more to try to even out alar base asymmetry than only reduce width.
Patients undergoing the more common form of Asian rhinoplasty designed to augment the nasal dorsum may be pleased to find that this operation alone is sufficient to adequately "mute" the impression of excessive width at the nasal base, thus allowing them to avoid the risks of additional alar excision surgery, such as visible scarring, postoperative imbalance, notching, or an over-operated appearance.
Nasal width should always be evaluated in the context of other facial anatomy and not as an isolated feature. If the the skull and face are naturally very wide, a narrow nose can appear inharmonious and "surgical."