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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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.The flare of your nostrils is partly due to the lack of projection of your tip, as seen on the profile view. A strong columella-strut, cartilage graft would also be beneficial. I've attached a photo demonstrating inconspicuous nostril narrowing. I hope this is helpful, and best regards.
Altering the nostril in Rhinoplasty
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.
Nasal base reduction is a complex procedure
Reduction of nostril size is a complex procedure, unpredictable scarring can lead to variable results. It is best to have the nose evaluated by a Facial Plastic Surgeon or someone with extensive nasal surgery experience. In many cases, rebalancing the nose with various surgical techniques ("rhinoplasty") can change the shape of the nose sufficiently that alar base reduction is not needed. That is why many experienced rhinoplasty surgeons perform this as the last procedure in the surgery.
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.
Nose tip will look bigger if you do alar reduction alone
Do not do alar base reduction alone. You won't like the result. The tip will look bigger if you do alar reduction alone. The tip needs to be reduced in width. With tip sutures the round nostrils will be converted to almond shaped nostrils. Then the surgeon can decide how much the base can be reduced to maintain between the tip width and alar base width.
You would also need alar rim cartilage grafts to address notching in the nostrils.
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