While there are many elements to facial appearance, the nose is a primary focal point and present with different shapes and sizes. In order to streamline the nasal profile, plastic surgeons often perform a 
Should the resection occur too far outside the rim, the delicate curvature of the alar rim and nasal base juncture create an unnatural perpendicular effect. The inferior arm of the wedge excision should not over extend into the alar-facial groove because scar indentation may result in the sebaceous skin. Asymmetry in the alar base region must be identified on preoperative photographs when planning the resection procedure.
As an initial step, the planned resection region is carefully mapped with a skin marker and a 1:100,000 part lidocaine with epinephrine concentrate is used on the alar base as well as the underlying deep soft tissue. Discretion is required as concentrate over-infiltration will distort the alar base and complicates symmetrical resection.
An eleven blade is used to resect the alar wedge taking care to preserve vestibular skin as the incision moves to the posterior. During the resection procedure, the margin of the incision is bevelled resulting in a lip of skin at the margin of the nostril. Following the wedge resection, bipolar cautery will achieve haemostasis. Following the margin realignment, the resection is closed with a 5.0 nylon suture and the bevelled edges of the incision will help to even the edges. To facilitate blood drainage, the defect in the posterior vestibular skin is left open.
As part of the recovery process, patients are instructed to clean incisions with hydrogen peroxide as this region of the nose has a high concentration of sebaceous glands and postoperative care helps prevent crust formation or infection. After three to five days, the sutures are removed and the incision is taped for an additional week to ten days. The alar base reduction is a specialized procedure that results in a streamlined profile with enhanced nasal symmetry.
