Narrowing the bottom of the nose A frequent complaint in my office is that “my nose is too wide at the bottom”. The patient frequently refers to the nostrils (or more correctly the “nasal ala”) and wants these narrowed. This is possible with alar base reduction techniques. The first step is to determine if this procedure is indicated. The nose may be out of proportion due to a low dorsum, or disproportion of the nostrils with the other surrounding structures. The patient may require a different procedure to balance the nose and make the bottom of the nose “fit” with the face. If it is determined that the alar base is too wide, the next step is to determine the best method to narrow the base. There are a variety of procedures to narrow the base. Many different incisions may be used to place an incision in a place where it will be inconspicuous. However, all incisions leave scars. It is not possible to make an incision without leaving a scar. The skill involves placing the incision so the scar will be least visible. Only the most experienced surgeons in rhinoplasty should consider this procedure. The results can seriously deform a nose and after completion this is a difficult problem to correct. Alar base complications with complaints from patients having had this done is one of the commonest problems I see in the office. If not completed by someone with experience in this area the results can be very unsatisfactory. Frequently I counsel patients not to have this done since the initial diagnosis is not correct. Often a better solution to the aesthetic challenge the patient is facing will give them a result they will be happy with. Patient coming to my office after having this procedure looking for a revision are often unhappy to hear that I cannot improve the appearance. They will have to live with the result. All patients should be very careful in seeking to narrow the width of the nose with alar base incisions.