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2026.06.17
Does the “Internal Approach” for Nostril Reduction Leave Less Visible Scars? How Does It Differ from the External Approach? How to Choose the Right Procedure for You
Specialist in rhinoplasty. He is a board certified plastic surgeon by the Japanese Society of Plastic and Reconstructive Surgery. Based on the principle of “maximum effect with minimum treatment,” I propose the best surgical techniques and plans for my patients from various angles. He specializes in designs that beautifully accentuate the "individuality" of the patient while taking into account the golden ratio of the face. In particular, we create full-custom-made prostheses by combining CT and Vectra data to create full-scale blueprints, which are then precisely finished based on clay prototypes handmade from scratch on a skull model. The shape of the prosthesis can be reproduced with high precision as per the presented simulation, so that even the most detailed wishes can be met and stable results can be achieved.
Hello!
My name is Yu Yagasugi, and I am a board-certified plastic surgeon recognized by the Japanese Society of Plastic and Reconstructive Surgery.
In this post, we’ll address a question we often receive from patients regarding alar reduction (nostril reduction)—a procedure we also perform at Bianca: “What’s the difference between the medial and lateral approaches?”
There are actually many different concerns regarding the nostrils, and simply making them smaller isn’t always the answer. As we delve deeper into these concerns during a consultation, some people say, “My nostrils stick out to the sides and are too noticeable,” while others say, “My nostrils are too large.”
If I had to sum up the difference between the internal and external approaches in a single sentence, it would be: “What specific nasal concerns can each method address?” I’ll explain the characteristics, advantages, and disadvantages of each surgical technique in an easy-to-understand way.
The Difference Between the “Internal Approach” and the “External Approach” in Alar Reduction (Nasal Wing Reduction)
Alar reduction (nasal wing reduction) is a surgical procedure in which a portion of the widely flared alae is removed to reduce the size of the alae and the nostrils.While there are various surgical techniques available, and they may differ depending on the clinic, the alar reduction (nose wing reduction) procedures performed at Bianca consist of three methods: the [medial approach], the [lateral approach], and the [flap method].
The internal approach is [a method that involves making an incision inside the nostril].
The internal approach is a surgical technique that involves removing excess skin from the inside of the nostrils to narrow the width of the alar base from the inside. One advantage of this method is that, since the incision is made inside the nostrils, the scar is less noticeable. It is primarily used for,Nasal Wing WidthThis is ideal for people with a wide distance between the bases of their nostrils (on both sides) or those who are self-conscious about having large, prominent nostrils.
The external approach is [a method that involves making an incision from the nostril outward].
The lateral approach is a surgical procedure in which skin is excised from inside the nostrils along the crease of the alar base and toward the outside to reduce the width of the alar base. It is suitable for individuals with a large alar base or whose alar base and nostrils are round and protrude outward (a “cross-legged nose”).
Compared to the internal approach, the scar is on the outside; however, since the incision is generally made along the groove of the nostrils, the scar tends to be less noticeable, although this varies from person to person. However, depending on how the tissue is excised, the result can appear unnatural, so this procedure requires a high level of technical skill and aesthetic judgment on the part of the surgeon.
The flap method is an application of the internal approach, which involves making a flap-like incision inside the nostril.
The flap method is a surgical technique based on the internal approach, which involves making a flap-like incision inside the nostrils. The traditional internal approach had the disadvantage that “the skin of the alar base is stiff, so the area pulled back by the sutures may revert to its original position.”
However, with the introduction of the “flap method”—which involves leaving the incision site as a flap and causing the flaps to adhere to one another—it has become possible to perform procedures that take the risk of recurrence into account.
Combined Treatment Using the External and Internal Methods
After examining the condition of the nostrils—such as their width or thickness—we may recommend a combination of the internal approach (flap method) and the external approach, rather than using the internal approach alone. In this case, incisions will be made on both the outside and inside of the nose, but this allows us to achieve a more natural and ideal balance than would be possible with either approach alone. During the consultation, we will carefully examine the shape of your nose and work with you to determine the surgical approach that is best suited for you.
Case Studies of Alar Reduction
Here are some case studies of patients who underwent alar reduction at Bianca. In fact, we often receive requests to combine alar reduction with other rhinoplasty procedures to achieve overall balance in the nose.
This case study demonstrates a procedure that preserves the masculine characteristics inherent in a naturally hooked nose while making the entire nose smaller and more defined. The nostrils were also refined from both the inner and outer sides to make the nasal openings appear smaller and less noticeable.
[Procedure Names] Rhinoplasty, Septum Extension (using septal cartilage, auricular cartilage, or autologous cartilage), Nasal Tip Reduction, Alar Reduction
[Photo Caption] Left: Before treatment; Right: 8 months after treatment
[Costs] Rhinoplasty: 385,000 yen; Septal Extension Surgery (using septal cartilage, auricular cartilage, or autologous cartilage): 770,000 yen; Nasal Tip Reduction (when performed concurrently with nasal septum extension) 165,000 yen, Nasal Wing Reduction 437,800 yen
[Side Effects, Risks, etc.] Crooked bridge or tip of the nose, scarring, relapse, infection, etc.
At BIANCA, our “nose surgery specialists” recommend the ideal balance for your nostrils.
The goal of alar reduction surgery is not merely to make the nostrils smaller. It is also extremely important that the overall balance of the nostrils—specifically, the point formed by connecting the bases of the left and right nostrils to the base of the nasal septum—forms a beautiful downward-pointing triangle when viewed from the front.
Furthermore, among those who request alar reduction because they “want to make their nose smaller overall” or “want to narrow the width of their nose,” some are found, upon examination, to be unsuitable candidates for the procedure. In other words, the alae are not necessarily the sole cause of a large, prominent nose.
If alar reduction surgery is performed on someone who is not a suitable candidate, the result may look unnatural—such as the nostrils alone becoming smaller or the nose appearing to be flattened against the cheeks.
For rhinoplasty procedures—including Bianca’s alar reduction—we place great emphasis on thorough consultations that make full use of the 3D simulation technology “VECTRA®.” The nose, situated at the center of the face, is a feature that significantly influences the overall impression and balance of the face. That is precisely why we spare no time in consultations that allow us to work closely with patients to meticulously refine the final result and achieve a beautiful nose.
In our simulations using Vectra, we make adjustments down to the millimeter and work to share our vision with the patient repeatedly. We believe it is very important to be as attentive as possible to the patient’s concerns while also focusing on achieving a natural and beautiful result that maintains the overall balance of the face.
▶Learn more about BIANCA's "Nasal Wing Reduction (Alar Reduction)"
Frequently Asked Questions (FAQ)
Finally, here are answers to some common questions patients ask about alar reduction.
Is the internal approach to alar reduction very painful?
While the perception of pain varies from person to person, we use local anesthesia during the procedure, so you won’t experience any severe pain. For those concerned about pain, we also offer optional relaxation anesthesia or intravenous anesthesia; please feel free to ask us about these options.
Does the internal approach for alar reduction leave noticeable scars?
With the internal approach, the incision is made inside the nostrils, so the scar tends to be relatively inconspicuous. With the external approach, the incision is made along the crease of the nostrils; while results may vary from person to person, the scar generally fades over time.
What is the downtime immediately after an internal rhinoplasty procedure to reduce the size of the nostrils?
Swelling typically lasts for a few days, and bruising lasts for about 10 days; although this varies from person to person, these symptoms usually subside gradually. Stitches are removed about one week later. We also prescribe pain medication to manage postoperative pain.
Is it possible for the results of the internal rhinoplasty procedure to revert?
Although results vary from person to person, we cannot guarantee that there will be absolutely no relapse. However, it is possible to minimize the risk of relapse by using the flap method or combining the medial and lateral approaches. I will explain this in more detail during your consultation.
Is there a difference in cost between the internal and external methods for alar reduction?
At Bianca, there is no difference in cost between the internal and external methods. However, the cost of the procedure may vary depending on the number of incisions and whether it is combined with other treatments. For more details, please consult with a doctor or staff member during your visit, or contact us.
"Should I choose the medial or lateral approach for alar reduction?" If you're unsure, be sure to visit BIANCA.
There are several methods for alar reduction—the medial approach, the lateral approach, and the flap technique—and you can choose the one that best suits your desired outcome and the condition of your nostrils. In addition to using a single surgical technique, we can take a flexible approach by combining multiple techniques or performing the procedure in conjunction with other rhinoplasty procedures.
However, to achieve natural and beautiful nostrils while taking the patient’s wishes into account, it is important to design the procedure with the overall balance of the face in mind. If you are “unsure whether to choose the internal or external approach for nostril reduction” or “want to avoid complications from rhinoplasty,” please schedule a consultation to discuss your options.
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▷Read other blog posts by Dr. Yagasugi
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