Background <p>Hanging alae is a common aesthetic problem in Southeast Asian noses. The alar overhang gives a poor aesthetic relation between the alar and columellar base described as a “heavy hypertrophic alar” appearance. Alar lift surgery is an integral part of any rhinoplasty procedure, but is often overlooked by surgeons performing rhinoplasty. Unnatural looking scar caused by skin graft or anatomic junction disruption is often found after alar base lift surgery. Hiding the incision along the nasolabial fold with a rotation flap can reduce the tension during wound healing, decrease length discrepancy caused by vertical reduction, and close the defect after vertical lift of the alar component.</p> Methods <p>After vertical reduction and lift of the lateral part of the ala, the basal defect is repaired with a small rotation flap along the nasolabial fold; the alar base rotation flap (ABRF). All the patient received alar base lift with an ABRF, and received 2D photometric evaluation before and after surgery.</p> Results <p>No tip circulation compromise was noted. All patient healed well with a barely noticeable scar, and an improved alar-columellar relationship (ACR). The vertical alar base distance index decreased 3.38% (<i>p</i> &lt; 0.005), and alar columellar angle decreased 15.8° (<i>p</i> &lt; 0.005).</p> Conclusion <p>Alar base lift with ABRF improves the ACR, and provides an elevated alar base position with a less visible scar.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a></p>