In short. The bony vault and the alar base are measured at different levels, have different causes, and are not changed by the same operation. How the two are told apart.
Key points
- The vault and the base sit at different heights and are measured against different landmarks.
- Narrowing the base does not narrow the vault, and moving the vault does not close a wide nostril span.
- Where both are wide they are two decisions rather than one, and can be taken at different times or not at all.
When someone says a nose is wide, they are describing the widest point of it in a front view. In most faces that point is the alar base, at the bottom of the nose. But a nose can also be wide at the top, where the two nasal bones form an arch with the maxilla on either side, and the two are measured at different levels, arise from different causes and are not changed by the same operation.
The upper third is bone
The bony vault is the upper third of the nose. It is an arch rather than a solid block: the two nasal bones meet in the middle, each supported on its outer side by the frontal process of the maxilla, and beneath them sits the opening in the skull that the nose occupies. How wide that arch is depends on the bones themselves. Bone responds to being moved and to little else, so filler over a wide vault adds height in front of it without narrowing it, and nothing applied to the skin changes the width of bone.
The lower third is soft tissue
The alar base is skin, the fibrofatty tissue of the ala, the lateral crus of the lower lateral cartilage and the maxilla underneath. Its span is set by where the nostril openings sit and how the base relates to the cheek. It is the part that moves when you smile, the part widest in most front views, and the part people almost always mean. It is also the part where narrowing costs a scar, because making a span smaller means taking soft tissue away.
One word, two levels
The vault and the base sit at different heights and are measured against different landmarks. Narrowing the base does not narrow the vault, and moving the vault does not close a wide nostril span. Where both are wide they are two decisions rather than one, and can be taken at different times or not at all.
Why the distinction changes the plan
An operation that moves the bony vault is an osteotomy: the bone is cut in a controlled way and moved inward. An operation that narrows the alar base removes a wedge of soft tissue and closes the gap, leaving a scar in a crease beside the nostril. The recoveries differ, the risks differ, and only one leaves a mark a patient will find afterwards. Where the width comes from a tip with no defining break, neither operation is the answer.
Stop and ask questions if
- Nobody has told you which level is the wide one, or how it was measured.
- The same plan is offered for a wide bridge and for a wide nostril span.
- Narrowing the alar base is described as leaving no visible mark.
Separating the two takes minutes in an examination and cannot be done from a photograph. What the examination covers, and what each finding decides, is set out in what actually sets the nostril span.
Frequently asked questions
How can I tell whether my nasal bones or my alar base are the wide part?
By looking at where the nose is widest in a front view and at what level that point sits. The bony vault is the upper third, level with the inner corners of the eyes, and it is hard to the touch. The alar base is the lower third, at the nostrils, and it is soft and moves when you smile. The two can both be wide, and an examination measures each against its own landmarks rather than judging the nose by its outline alone.
Does an osteotomy narrow the whole nose or only the bridge?
Only the bony vault, which is the upper third. The bone is cut in a controlled way and the two sides are brought inward, which changes the width of the arch and, where a hump is reduced at the same time, the profile. It does not close a wide nostril span, because the alar base is soft tissue below the bone and sits outside the arch that was moved. Where both levels are wide, they are two separate procedures.
Why is a wide alar base treated differently from a wide bridge?
Because one is bone and the other is soft tissue, and the two are changed by different means. Bone is moved and does not need to be removed, so an osteotomy leaves no external scar. The alar base can only be made narrower by taking tissue away, which needs an incision placed in a crease beside the nostril and leaves a permanent mark. That trade, rather than the size of the change, is what separates the two decisions.
Risks & Limitations
- Every treatment on this ladder carries risk, and no result can be guaranteed.
- Narrowing the alar base leaves a permanent scar. It matures and fades over about a year, and it does not disappear.
- Every operation that narrows a nose also narrows the passage through it, which is why the airway is examined before any plan is made.
- An over-narrowed nose is difficult to reverse, because correcting it means adding tissue rather than removing it.
When to Seek Care
- A change in vision, or severe eye pain, after any filler or operation on the nose — seek emergency care immediately.
- Rapidly increasing swelling, spreading redness, warmth or fever after treatment on the nose — seek care promptly.
- Bleeding from the nose that does not stop with gentle pressure, or new blockage that is worse on one side.
- A growth, or a lesion on the skin of the nose that bleeds or does not heal.
- After an injury, where the shape of the nose has changed or breathing is affected.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — rhinoplasty and patient safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.