Alar Width Reduction or a Weir Excision for Wide, Bulbous Nose?

Hi,

In your frontal view, it's hard to appreciate the overprojection of the nasal tip. You do have a wide nasal tip, which is a combination of thick nasal skin and thick lower lateral cartilage. Rhinoplasty could improve the appearance of your nasal tip significantly. Given the thickness of your nasal skin, however, you will never have a truly refined appearance to the nasal tip.

From the frontal view, it's hard to appreciate a need for Weir excision - a worm's eye view might allow better assessment.

Hope this helps. Best of luck.

It is very difficult to do an alar width reduction. However, Weir excision can be done as an alarplasty procedure to narrow the nostrils. Full delivery dome suturing techniques and removal of some of the tip cartilage can all be done at the same time to reduce and feminize the size of the bulbous tip.

Even with the thickened skin you would see a good improvement with refinement of the tip of your nose and reduction of the height and width of the side of your nostrils. An experienced plastic surgeon should be able to suggest this for you.

Hope this helps.

From your photos it appears that your upper 2/3 of your nose is quite narrow. While I only see your front view, I understand you concern. Yes, it appears that the lower 1/3 is quite wide. Tip refinement can be achieved as well as base narrowing. If your skin is very thick the results will not be as well defined as someone with thin skin.

It would have been VERY helpful for us to see a SIDE picture of the nose as well. It is hard to give advice without seeing a full series of nasal views (Front, Front looking over so nostrils are seen (worm's eye view), Oblique Side and side).

The nasal tip is made up of two cartilage arches called the LOWER LATERAL CARTILAGES. The thickness of the arches and their relations to one another determines the shape of the tip. From the frontal view you have a very bulbous tip. That can be corrected by NARROWING the width of your very wide Lower lateral cartilages and further suture shaping the tip. The amount of tip projection can be reduced with various degrees of separation of the tip from the front edge of the cartilage septum (by a so called transfixion incision). In rate cases, other things such as tip grafts can be used. I do NOT think that a Weir excision is required here UNLESS the tip is lowered too much. In that case the outer walls of the nostrils will bow out and then a Weir may be called for.

Good Luck.

The Weir procedure is a specific type of alar width reduction (AWR), however, many surgeons use the words interchangeably. It can be a very gratifying procedure depending on the problems. For instance, if the nostrils are small the incision should stay outside the nostril. If the nostrils are large, going in the nostril with the incisions can make the nostrils smaller. Also, the way the base of the nostril attaches to the cheek/lip junction makes a difference. More narrowing can be accomplished if the nostril flares outward before the junction.

Hi,

Bulbous tips can be challenging but not impossible to refine. The reason patients have bulbous tips include:

thick skin
fatty tissue under the skin
weak or poorly developed tip cartilage
In order to correct this, I my experience, the best way is through an open rhinoplasty approach. This allows the surgeon to remove tip fat, thin the tip skin and add supporting cartilage to the tip.

As far as the tip being overprojected, it may be that your dorsum or bridge is much lower than your tip. Therefore, reducing your tip and elevating your bridge will allow a more balanced look to your nose.

Lastly, no is a hopeless case.

Best of Luck

Dr. S.

 I think that an experienced rhinoplasty surgeon could make improvements to your nose though it will never be classically beautiful.  The thick skin on the tip will limit the sculpting of the tip and the base will need narrowing as the last step of surgery.