Weir Reduction or Another Procedure for Large Nose?

I've been considering a rhinoplasty to reduce the large appearance of my nose. I'm happy with the profile, but not with the width. A couple doctors suggested weir reduction only, but I'm actually more concerned with the width right above the tip. I'd prefer definition here as opposed to only reducing the weirs. I DON'T WANT a dramatic change at all, I prefer not to have co-workers notice right off the bat. I'm worried a "weir reduction" only will look distorted and squished. Is it possible to create a slightly smaller refined version of my current nose, or is weir the best procedure?

Doctor Answers 16

Rhinoplasty for Large Nose Without Weir Excision

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Hi Pink,

Your nasal width fullness just above your nasal tip can be narrowed and refined giving your nose more definition.

By narrowing that area, your lower nasal width will be proportionally larger. Rhinoplasty is sculpting. Changing one area often requires a small change in the adjacent area to maintain a natural and smooth transition. Additionally, narrowing and defining the supra-tip area will likely exaggerate the wideness of the upper 1/3 of your nose, necessitating narrowing of your nasal bones.

That having been said, depending upon your specific anatomy, it may be possible to accomplish what you desire without Weirs. If your nose appears to be too wide after you have healed from surgery, the ala may be narrowed under local anesthesia in your rhinoplasty surgeon's office.

Your question can accurately be answered only at a consultation with examination of your nose and full discussion of your goals. Choose your rhinoplasty surgeon carefully.

Good luck and be well.
Dr. P

Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Rhinoplasty to reduce large appearance of nose

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There are multiple procedures in the field of rhinoplasty that address wide mid third, upper third, and lower third of the nose or tip. All of which can be done through a closed or endonasal approach and give more or less of a dramatic change. The Weir reductions are only to reduce the size of the nostrils and will not affect the rest of the nose. It is best to consult with a surgeon who has done thousands of rhinoplasties prior to embarking on this and make sure there is good communication between you and the surgeon about your expected results.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Weir Reductions

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Weir reductions will not narrow your nose above the tip. Well-performed Weirs will not give you a distorted look. Without pictures it is difficult to make specific recommendations. It is important for you to change your nose to meet your expectations,regardless of what technique is used.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Beware of scars left behind by a Weir procedure

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Dear Pink

I think it would be important to define what you are not happy with and what type of procedures you would benefit from. As mentioned here this is very difficult to address with a visual aid to comment on. If your tip is too wide there are many maneuvers to narrow it, if your supratip is too wide, that can also be addressed. A weir excision could address a wide alar base, but can leave symmetric scar at the alar base. If not too much alar base reduction is necessary a sill reduction procedure can be performed by operating on the floor of the nose. These procedures would not narrow your tip, so a proper evaluation is of necessity.

Robert Schwarcz, MD
New York Oculoplastic Surgeon
4.5 out of 5 stars 23 reviews

Rhinoplasty and Weir excisions

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It's hard to give accurate advice without an examination, but based upon your complaints you will require more than Weir excisions alone to reduce the width of your nose. If the area in the region of the tip itself is wide, the cartilage can be reduced and sutures placed to narrow this region. If the area above that is wide, you may need bony or septal reduction. Your colleagues will not necessarily notice a change if you have a natural result. I recommend seeing a board-certified plastic surgeon or ENT who has significant experience with rhinoplasty, and who can address your specific concerns. Good luck, /nsn.

Procedure for large nose

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It is possible to refine the width right above the tip without doing weir incisions. You may perform osteotomies and narrow the bones slightly. Slight narrowing of the tip may help as well. I would really need to see photos to determine the best options for you. Thank you and best of luck.

Dr. Nassif

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Wide nose and Weir excisions

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I think you can only get a useful response if you submit photos of the front, bottom ,and side of the nose with your questions. It is rare that an alar base narrowing procedure alone would benefit the patient , but I have done a few cases  with only that maneuver.

Sheldon S. Kabaker, MD FACS
San Francisco Facial Plastic Surgeon

Options for rhinoplasty and wide nose.

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These are two completely different options and will result in two different appearances. The area to which you refer is called the supratip break. IF this is thinned it give the appearance of rotating the tip slightly upwards but will do little to decrease the width of the nose and definitely not the nostrils. A weir prcedure WILL decrease the width of the nose and nostrils

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Rhinoplasty Surgery may change the width of your nose.

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If you're unhappy with the wide appearance of your nose, this can be narrowed with Rhinoplasty Surgery. A Weir-procedure is resection of the nostril where it attaches to your cheek. I'm not a big fan of this procedure since you may have visible scarring. I like to narrow nostrils by excising a portion of the nasal-sill which results in inconspicuous scarring.

Feel free to email a full face frontal and profile photo, and I'll be happy to share my thoughts with you.

I've attached a link to my Rhinoplasty gallery for your perusal.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Weirs excisions might not be what you need/want

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It is very difficult to advise you without a photo, but what you describe does not sound like something that is improved by Weir's excisions. Weirs excisions, also known as alar base reductions, make the width of the nose smaller at the nostrils, or make the nostrils smaller (depending on how the excision is preformed).

To see if it is really your nostrils that contribute to the width of your nose, draw a line straight down from the corner of your eye (by your nose). If the nostrils lie outside that line, they are too wide and an alar reduction will help.

The width you describe "above the tip", sounds like it is actually from prominence of the lower lateral cartilages. Reduction in this area is performed by a rhinoplasty procedure.

Make sure you are clear describing to the surgeon exactly where you see the problem with the width so they can advise you appropriately.

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

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.