Alarplasty — Nostril Reduction Surgery Sydney, Australia

Alarplasty at a glance

What is alarplasty?

Alarplasty is surgery to adjust the alar base and the shape of the nostrils. The “alar base” is the outer lower part of the nostril, where the nostril sidewall meets the cheek and the upper lip. The most common reasons patients consider alarplasty are wide nostrils, outward flaring of the nostril rim (alar flare), or nostril asymmetry that has been present from birth, developed after trauma, or followed a previous rhinoplasty.

Alarplasty is a distinct procedure from full cosmetic rhinoplasty (which addresses the bridge, tip, and overall shape), tip rhinoplasty (which addresses the tip cartilages and tip projection or rotation), and septoplasty (which addresses the internal nasal septum for breathing problems). Alarplasty by itself does not change the bridge, the dorsal hump, the height of the nose, the tip projection, or the airway. Where the patient’s concerns include any of these, a different procedure or a combined plan is required.

Alarplasty may be performed as a standalone operation when the alar base is the only concern, or as part of a rhinoplasty operation when alar base work is one component of a broader plan. For ethnic rhinoplasty in particular, alar base reduction is frequently part of the surgical plan rather than a separate operation; see our ethnic rhinoplasty page for context. For an overview of all nose surgery options, see our nose surgery hub.

Is alarplasty the right nose procedure?

Patients commonly arrive uncertain whether their concern relates to the nostrils, the nasal tip, the bridge, or the breathing function of the nose. The table below summarises which procedure is most relevant to which patient concern.

The clinical assessment at consultation works through where your concern actually sits on this table. Many patients describe wanting “the nose smaller” when what would actually be addressed is the alar base, the tip, or the bridge specifically. Identifying the right procedure is the first step.

What alarplasty may address

Alarplasty addresses a defined set of nostril and alar base concerns. The four subsections below cover the most common.

Wide nostril base

A wide nostril base refers to nostril width on the basal view (looking up at the underside of the nose). It is often discussed in relation to the rest of the nose: how the nostrils sit in proportion to the tip, the bridge, the face width, and the mouth. Alarplasty narrows the nostril base by removing a small amount of tissue at the outer edge of each nostril or at the nostril sill, depending on which technique applies to the anatomy. Conservative narrowing is important because over-reduction is difficult to correct and can produce an unnaturally pinched or asymmetric result.

Alar flare

Alar flare refers to the outward curve of the nostril rim, particularly visible when the nose is viewed from the front or in three-quarter view. A patient with alar flare has nostrils that curve outward beyond the rest of the nose. Alarplasty addresses alar flare by removing a small wedge of tissue from the alar rim, bringing the curve closer in toward the central nose. The visible effect is usually a more linear nostril rim outline rather than a flared one.

Nostril asymmetry

Nostril asymmetry can be present from birth, can follow nasal trauma, or can occur after previous rhinoplasty. Mild asymmetry is normal and is present in most people; surgery is considered where the asymmetry is clinically significant and bothersome. Alarplasty can address some forms of nostril asymmetry by adjusting one or both sides to bring the nostrils closer to symmetrical. Complete symmetry is not a realistic goal; the goal is to reduce asymmetry to within a normal range.

Alar base in the context of ethnic rhinoplasty

Alar base reduction is one of the most common components of ethnic rhinoplasty, because anatomical patterns associated with several backgrounds (notably Asian, African, Afro-Caribbean, and some Middle Eastern and Hispanic anatomies) include wider alar base width relative to the rest of the nose. Where alar base work is part of a broader anatomy-led rhinoplasty plan that also addresses the bridge, tip, or both, the procedure is best framed as ethnic rhinoplasty with an alarplasty component, rather than standalone alarplasty. For patients whose anatomy includes multiple nasal features beyond the alar base, see our ethnic rhinoplasty page.

Alarplasty techniques

Several techniques exist for alarplasty, and the appropriate technique depends on the specific anatomy, the nature of the concern (width, flare, asymmetry, or a combination), the skin quality, and whether the operation is standalone or combined with rhinoplasty.

Several principles guide the technique choice:

• Conservative tissue removal: A small change in nostril tissue produces a visible change in nostril shape. Over-resection is difficult to correct, so the surgical plan errs toward conservative removal.
• Symmetry between sides: Where both nostrils are being modified, careful marking and measurement aims to produce comparable changes on both sides.
• Scar placement at natural creases: Incisions are placed where existing skin creases or anatomical junctions are likely to hide the scar, though scars can still develop and visibility varies between patients.
• Closure technique: Layered closure with fine sutures is used to minimise tension and reduce visible scarring.
• Combined rhinoplasty cases: Where alarplasty is part of a rhinoplasty operation, the alar base work is usually performed after the bridge and tip have been adjusted, so that the alar base is assessed against the new nasal shape.

The technique decision is made at consultation based on the clinical examination, not based on which technique is most familiar or fashionable. Different patients with different anatomical patterns need different techniques, and patients with multiple concerns often need a combined approach.

Alarplasty as part of rhinoplasty

Where alarplasty is performed as a component of rhinoplasty (cosmetic, tip, or ethnic), the planning logic differs from standalone alarplasty. The alar base is assessed in relation to the new nasal shape that the rhinoplasty will produce, not the current nasal shape.

This matters because changes to the bridge or tip can alter how the nostrils look without any direct work on the alar base. Tip rotation can change apparent nostril visibility from the front. Bridge reduction can change the proportional relationship between the nostrils and the rest of the nose. A patient whose nostrils look wide before surgery may not need alar base reduction if the bridge and tip changes alone produce balance; conversely, a patient whose nostrils look proportional before surgery may need alar base reduction after bridge or tip changes alter the relationships.

For combined cases, alarplasty is therefore the last component of the surgical plan to be finalised, after the bridge and tip plan is established. This planning approach reduces the risk of over-narrowing the alar base before the rest of the nose has been changed.

Where alarplasty is the right addition to a rhinoplasty case, the relevant parent procedure pages set out the broader operation and cost framework: cosmetic rhinoplasty, tip rhinoplasty, or ethnic rhinoplasty.

Alarplasty scars and incision placement

Alarplasty leaves scars. Where the surgical plan involves removing tissue at the alar base or alar rim, an incision is required, and the incision becomes a scar as it heals. The relevant questions are where the scar will sit, how visible it is likely to be, and what factors affect that visibility.

Incision placement depends on the technique:

• Alar wedge excision: The incision sits in or near the alar-facial groove, the natural crease where the nostril meets the cheek. The crease itself helps disguise the healed scar, but the scar is not invisible.
• Nostril sill or alar base resection: The incision sits at the nostril sill (the very base of the nostril where it meets the upper lip area). Scars here can be subtle but are still present.
• V-Y advancement: Incisions sit inside the nostril where they are not externally visible, though external healing patterns can still vary.

Scar visibility depends on:

• Skin type: Some skin types are more prone to scarring than others
• Healing tendency: Patients with a history of hypertrophic or keloid scarring elsewhere on the body are at higher risk
• Sun exposure during healing: Sun exposure on healing scars can permanently affect pigmentation
• Surgical technique: Tension on the closure, suture choice, and closure technique affect outcomes
• Aftercare: Scar care instructions are important during the first 6 to 12 months
• Individual variation: Even with identical surgical technique and aftercare, scar outcomes vary between patients

The scars settle over 6 to 12 months. Early scars are typically pink or red, gradually fading toward skin colour as they mature. Persistent scar concerns, hypertrophic scarring, or scar widening can occur and may require additional scar management or, occasionally, revision.

Patients with a history of keloid or hypertrophic scarring should discuss this at consultation; it does not necessarily rule out alarplasty, but it does affect risk discussion and may affect technique choice.

Are you a suitable candidate for alarplasty?

Alarplasty is appropriate for patients whose concerns are specifically about the alar base, nostrils, or nostril asymmetry, and where the clinical assessment supports surgical change.

Clinical suitability

• Nasal growth is complete (typically 17 years and older)
• Good general health, with any chronic conditions well controlled
• Non-smoker, or willing to stop smoking for a defined period before and after surgery
• Specific identifiable concern about the alar base, nostril width, alar flare, or nostril asymmetry
• Adequate alar base anatomy for the planned surgical work
• No history of severe keloid scarring (or willingness to accept additional scar-related risk if mild scarring history is present)
• Realistic expectations about scars, symmetry, and the limits of what alarplasty can achieve

When alarplasty may not be enough

Several situations indicate that alarplasty alone is not the right pathway:

• Bulbous or wide nasal tip as primary concern: Tip rhinoplasty is the relevant procedure
• Dorsal hump, high bridge, or whole-nose change: Cosmetic rhinoplasty is the relevant procedure
• Breathing obstruction: Functional rhinoplasty or septoplasty is the relevant procedure
• Multiple concerns across bridge, tip, alar base, and identity: Ethnic rhinoplasty is the relevant framework
• Previous nasal surgery with complications: Revision rhinoplasty assessment is the relevant pathway
• Wanting overall nose narrowing: Alarplasty narrows the nostril base, not the rest of the nose; this expectation needs reframing
• Unrealistic symmetry expectations: Patients seeking complete symmetry need a different conversation about realistic outcomes

Where these factors apply, Dr Turner discusses what the appropriate pathway is at consultation, which may not be alarplasty.

The alarplasty consultation process

Every alarplasty patient follows a structured consultation process, in line with Medical Board and AHPRA requirements for cosmetic surgery.

How alarplasty is performed

Standalone alarplasty is performed under general anaesthesia at an accredited Sydney private hospital. The procedure typically takes approximately 1 hour. Patients are discharged the same day. Where alarplasty is performed as part of a combined rhinoplasty operation, the total operating time and recovery are determined by the parent rhinoplasty procedure rather than the alarplasty component.

The surgical steps for standalone alarplasty are:

• Pre-operative marking: The patient is marked while seated upright so that the alar base proportions are assessed in their natural position, not while lying flat
• Anaesthesia: General anaesthesia administered by a specialist anaesthetist
• Incisions: Made according to the planned technique (alar-facial groove for wedge excision; nostril sill for sill resection; both for combined approach; internal nostril for V-Y advancement)
• Tissue removal or repositioning: A small amount of tissue is removed or repositioned according to the surgical plan
• Layered closure: Deep sutures support the deeper tissue layers; fine surface sutures close the skin
• Dressings: Small dressings applied as required

Sutures are typically removed at approximately one week. Scar care instructions are provided and followed for the first 6 to 12 months.

Cost of alarplasty in Sydney

Alarplasty costs are determined at consultation based on the specifics of the surgical plan. The cost depends on several factors:

• Standalone vs combined with rhinoplasty: Standalone alarplasty has its own fee structure; when alarplasty is part of a rhinoplasty operation (cosmetic, tip, or ethnic), the cost is handled by the parent rhinoplasty procedure and not separately
• Surgical technique: Single technique versus combined wedge and sill, or V-Y advancement, affects operating time and complexity
• Anaesthesia: Specialist anaesthetist fee
• Hospital admission: Accredited Sydney private hospital day-surgery admission
• Surgical complexity: Symmetry corrections or revision of previous alarplasty are more complex than standard standalone cases
• Surgeon fee: Reflects the planning, surgical time, and post-operative care included

The initial consultation fee is $450. A formal quote is provided after consultation, once the surgical plan is finalised.

Cosmetic alarplasty is generally not Medicare-eligible, because alar base width and nostril shape are cosmetic rather than functional concerns. Medicare contribution may apply where the surgical plan includes a documented functional component (such as septoplasty for breathing problems performed alongside cosmetic work), but the alarplasty component itself remains private.

For a detailed cost breakdown across nose surgery procedures, see our rhinoplasty and nose surgery cost guide.

Alarplasty recovery

Recovery from standalone alarplasty is generally faster than recovery from rhinoplasty because the surgical work is localised to the alar base rather than involving the entire nose. Most patients return to office-based work within 1 to 2 weeks. Scar maturation takes considerably longer.

Patients are seen for follow-up at suture removal (approximately 1 week), then at 6 weeks, 3 months, and 6 months. Where alarplasty is combined with rhinoplasty, the recovery timeline follows the parent rhinoplasty procedure, which is longer.

For broader nose surgery recovery context, see our rhinoplasty recovery timeline guide.

Alarplasty risks and complications

Alarplasty is invasive surgery and carries specific risks. These include:

• Visible scarring: Scars at the alar-facial groove or nostril sill can be visible, particularly during the first 6 to 12 months of maturation; hypertrophic or widened scars can develop
• Asymmetry: Even with careful planning, post-operative asymmetry can occur; complete symmetry cannot be guaranteed
• Over-reduction: Because alarplasty removes tissue, over-reduction is a specific risk; over-reduction can be difficult to correct
• Nostril distortion or alar notching: Changes to the natural curve of the nostril rim or notching at the incision site
• Bleeding: Significant post-operative bleeding is uncommon but possible
• Infection: Antibiotic prophylaxis is used; infection remains a recognised risk
• Delayed healing or wound separation: Particularly where tension on the closure is high
• Changes in nasal sensation: Temporary numbness around the alar base is common; persistent sensory change is uncommon
• Dissatisfaction with the cosmetic result: Subjective satisfaction with nostril shape is patient-dependent
• Need for revision surgery: Some patients require touch-up procedures
• General anaesthetic risks: Reactions to medications, breathing difficulties, and rarely more serious complications

The most important risk to understand in advance is that alarplasty is not simply reversible. Where tissue has been removed, restoring it is difficult and revision options are limited. This is why conservative tissue removal is built into the surgical plan, and why patient expectations are discussed in detail before surgery is scheduled.

The individual risk profile for your case depends on your anatomy, skin type, scarring history, medical history, smoking status, and the specifics of the surgical plan. Dr Turner discusses the specific risks relevant to your case in detail at consultation.

Related nose surgery procedures

If alarplasty is not the right pathway for your concerns, the pages below cover related procedures.

Helpful guides about alarplasty and nostril reshaping

The articles below provide deeper context on the considerations that often come up in alarplasty assessment.

• Ethnic rhinoplasty Sydney: Where alar base reduction sits within broader anatomy-led rhinoplasty planning
• Middle Eastern rhinoplasty Sydney: Alar base considerations specific to Middle Eastern anatomical patterns
• Rhinoplasty and nose surgery cost guide: Detailed breakdown of surgical, anaesthetic, and hospital fees across nose surgery procedures
• Rhinoplasty recovery timeline: Week-by-week guide applicable to alarplasty and combined cases
• How to choose a rhinoplasty surgeon: What credentials, experience, and consultation signals to look for

Consult with Dr Scott J Turner

Dr Turner consults for alarplasty in Sydney at Bondi Junction and Manly. He also sees patients in Brisbane, Canberra, Newcastle, and the Gold Coast. Surgery is performed in Sydney at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why.

Contact the practice to arrange a consultation, or read more about Dr Turner’s background and training.

Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney Clinic | DrTurner.com.au