I'm having weir excisions done to narrow the flare of my nostrils. My physician recommends sill excisions, but from what I've read to reduce the flare of my nostril (which is what I want) I would have to have wedge excisions. I also read that sill excisions may increase the flare of my nostrils. Which excision would be best?
Best Rhinoplasty Excision to Narrow Flared Nostrils?
Doctor Answers (13)
Rhinoplasty nasal sill excisions for a less noticeable incision and natural final result
I prefer nasal sill excisions, along the floor of the nostril, rather than Weir excisions, adjacent to the sides of the nose, since I believe the scar of the sill excision is less noticeable and the final result is more natural. Recontouring of the lateral cartilage along the interior and inferior rim of the nose may also help to decrease the flaring of your nose. This is particularly true if the cartilage in this location is thick and strong. You may also consider increasing the height of your nasal dorsum, to make the natural flare of your nostrils less obvious.
Excisions to narrow flared nostrils
The flare that is present in the nostrils will be made worse by Weir alarplasty excisions. A composite graft of skin and cartilage can be taken from the ear and placed inside the nostril at the highest portion of the nostril arch, which will bring the nostril rim down. Then it is a good idea to have the nasal base reduced. Composite grafts should be done prior to embarking on Weir excisions for fear of making the arches even higher than they currently are.
See an experienced rhinoplasty surgeon.
You have several other issues to deal with as well. You have an under projected tip, retracted alae, etc. You should see a rhinoplasty specialist before having this done and let him guide you in the multiple issues involved. I have been doing revision rhinoplasty for more than 30 years and I often see patients who were given an answer about one issue and then I have to repair the other issues they were not informed of.
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Altering the nostril in Rhinoplasty
The photo you have provided is gives a somewhat limited view and makes it difficult to answer the question with 100% confidence. That said, your nostrils do appear to insert fairly laterally (wide) along the floor of the nose, and likely will require nasal sill incisions. Your surgeon may elect to perform minor alar wedge excisions but, should be conservative as it is definitely preferable to need slightly more narrowing than to try to correct stenosis. The more interesting finding on your provided photo is the alar retraction you exibit. The degree of retraction will require grafting of cartilage and possibly a composite cartilage--skin graft to lower the height of the nostril on lateral view.
Wide nostrils and weir excisions or
From the information provided by the photographs (which is limited) I would also recommend sill excisions. The nostrils themselvs seem small whereas your nostril floor or sill appears wide. From the side view your alar rims appears retracted, which is a more difficult problem to treat and may require grafts. Although you may not necessarily decide to treat this you should be aware of it and discuss it with your surgeon.
Rhinoplasty Surgery may correct flared nostrils.
I read your question, and reviewed your photos. I prefer to narrow nostrils with an inconspicuous incision on the nasal sill. This approach minimizes the scarring often associated with a Weir excision.
Treating the "wide" nostril
Looking at your photos, there are other issues than just the size and flare of your nostrils. Your tip should also be addressed if you will be undergoing this surgery. You are under projected and need narrowing of the tip and additional projection. This will also help with the width of your nose, by addition projection you will have some decrease in the width, but not enough to avoid nostril recontouring. You also may benefit from alar grafts to help with the retracted nostrils. This is tricky and difficult to fix completely as you appear to be fairly retracted, but it will help.
Correction of alar flare has multiple approaches
The topic of correction of alar flare, nostril size, heaviness in the lobule, alar shape, are approached in rhinoplasty be variation of skin removal in the base of the nose and nostril. The procedures, or patterns if you will, are sometimes lumped together as 'Weir' procedures, thought indeed chapters have been written on them describing the various ideas and patterns and how they might be applied to effect alar or nostril shape. If you have worked closely with your surgeon and reviewed his ideas with computer simulation or other photographs, you should know what to expect from the shaping that will be applied. Often we will adjust our plan as the Weir is usually what we perform as the last step.
Judging from your photographs, I think that your surgeon is right. You will benefit from sill excisions.
Best of luck,
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.