Is narrowing the nostrils from the inside the same as doing it from the outside?

my doctor said he would like to narrow my nostrils from the inside but not the outside, and he wasn't clear on the technique he would use. Is that just a sill excision (or something else??) and not a wedge excision? A proper alar base reduction is always done from the outside, right? Can doing it from the inside be just as effective? Please reply!!

Doctor Answers 12

Weir excisions....and Sill excisions are totally different

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A weir excision is designed to narrow the width of the nasal alae...and specifically is used to reduce nasal/nostril "flare." Sill excisions are designed on the inside of the nostrils, and actually reduce the aperature of the nostril. Occasionally, patients are candidates for both and can have a combination excision performed.

Is narrowing the nostrils from the inside the same as doing it from the outside?

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No, they are two totally different techniques.  Reducing the actual nostril needs to be done "from the inside", while reducing the base width  of the nose (alar reduction)  is usually done "from the outside".  Your surgeon needs to be very clear on what he / she is recommending, and you need to be very clear on what to expect.  Because reducing the base (alar reduction) from the outside sometimes results in conspicuous scars which may become a lifetime problem for you.  Ask your doctor to show you some sample photos.  Hope that helps.

Alar base reduction

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Either approach is acceptable.  It all is based on how much of a nostril reduction is needed.  The external incision can remove more of the ala (nostril wings) and can narrow more.  Seek out a consult by a board-certified rhinoplasty expert who is adept at both.  Best wishes.

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 16 reviews

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Narrowing the nostrils

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 Narrowing the nostrils can name performed at a variety of techniques which include incisions on the inside and outside of the nostrils. For only mild widening, the incisions can be placed on the inside. If significant widening of the nostrils is present, an external incision is required.

Internal vs External Incision to Narrow Alar Base in Rhinoplasty

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Part of the decision-making process in choosing between these two incisions is what shape you are looking to get. The internal incision isn't visible from outside, but will usually give a more rounded look to the nostrils. The external incision generally makes the nostril less rounded. It depends on what you want to achieve shape-wise, and not solely on incision placement preference.

Malik Kutty, MD
Sugar Land Plastic Surgeon

Narrowing the Nostrils from Inside vs Outside

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Whenever possible I prefer narrowing the nostrils from the inside, the nostril sill incision, because it is easier to camouflage the scar. The external, alar base excision, is sometimes necessary but there is a greater risk of a less favorable scar.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Is narrowing the nostrils from the inside the same as doing it from the outside?

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Dear nosepatient1, It is important to know what your goals are for your results when determining which procedure will be used. You are probably correct in your terminology that narrowing the nostril from the inside is a sill excision which will not narrow the nostril as much as an alar base reduction. An alar base reduction is used most commonly in my practice and the incisions are hidden in the natural crease. Again, this is dependent on the patients need. Make sure you clarify with your surgeon what technique is being used and again what your desired result is. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
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Narrowing the nostrils from the inside

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Dear nosepatient1,

  • You can narrow the nostrils from inside the nose with a diamond shaped incision just behind the sill
  • I prefer this method as well because it does not leave visible scarring
  • The downside to the internal method is that you do cannot narrow the nostril as much as from the inside compared to the external approach
  • Although the scar hides well in SOME patients, other patients do not have the best anatomy to hide that external nostril scar
  • Additionally, if that incision is carried through the sill, it rarely, if ever, hides well enough not to be noticed
  • Take a look at before and after pictures to judge for yourself.  In my mind, it is a giveaway for rhinoplasty surgery
  • If your nose is still too broad after surgery, it can easily be converted to an external incision

Dr. Nima

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

Narrowing the nostrils

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Hi there, I think you are on the right track. Narrowing the nostril from inside probably means using a nasal sill incision. I suggest you contact your surgeon and clarify before surgery. Trust your surgeon to chose the best surgical technique for you but also clarify what your goal in nasal shape is. Good luck! 

Myriam Loyo, MD
Portland Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Nostril narrowing using an internal incision only.

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The procedures are quite different and accomplish different goals.  It is unusual to make only an internal incision.  The external incisions used are ordinarily quite camouflaged and hidden and barely if at all visible once healed.  An internal incision would only narrow the internal nostril diameter and not affect the external shape of the nostril.  

Jon A Perlman MD FACS
Certified, Am Board of Plastic Surgery
Extreme Makeover Surgeon ABC TV
Beverly Hills, Ca

Jon A. Perlman, MD
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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.