Changing the nostril wall thickness. What do these nostril wall excisions in the diagram accomplish? (photo)

I've performed this multiple times and I have not encountered scarring issues referenced by some. When the alar walls are extremely thick, the risk of scarring is worth the trade-off. I would not recommend it for a minor thickness problem. 

Thinning the nostril wall width (alar thickness) is challenging.  In this area of the nose there is no cartilaginous or bony structure--it is simply fibrous soft tissue beneath the skin.  For this reason, reduction requires removal of soft tissue, a process which is difficult to do precisely.  The other problem is it leaves an external skin scar which in some cases may be visible after surgery.  The method you show in the diagrams can reduce alar thickness, but the scars on the lower edge of the nostrils are less hidden than Weir or sill scars.  I perform a modification of this technique in which the scars are slightly inside the nostril to be better concealed, but it is technically more difficult.  In some cases, the nostril may be able to be thinned through a Weir incision, but again it is harder to do.

Hello. Sadly, these techniques are of limited value and effectiveness. Scars are visible and unpredictable and the degree of thining is limited. As a rule,  if you only see illustrations and no actual patient photos be leary. Dr. B