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

Question

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!!

Kevin Brenner, MD, FACS · Answer

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.

Nima Shemirani, MD · Answer

Dear nosepatient1,You can narrow the nostrils from inside the nose with a diamond shaped incision just behind the sillI prefer this method as well because it does not leave visible scarringThe downside to the internal method is that you do cannot narrow the nostril as much as from the inside compared to the external approachAlthough the scar hides well in SOME patients, other patients do not have the best anatomy to hide that external nostril scarAdditionally, if that incision is carried through the sill, it rarely, if ever, hides well enough not to be noticedTake a look at before and after pictures to judge for yourself.  In my mind, it is a giveaway for rhinoplasty surgeryIf your nose is still too broad after surgery, it can easily be converted to an external incisionBest,Dr. Nima

Adam Bryce Weinfeld, MD · Answer

addressing nostril size with soft tissue reduction is a powerful and important tool.it is generally done with an external incision that extends somewhat internally.  it can be done from the inside only but this is rare and does not achieve the same thing as the more standard approach.  there is no one right way.  the shape of the excision is customized to the nose to reduce width, flare, change shape, etc.  there are infinite shape for infinite individual needs.

William Portuese, MD · Answer

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.

Malik Kutty, MD · Answer

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.

Myriam Loyo, MD · Answer

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!

Arian Mowlavi, MD, FACS (license on probation) · Answer

Alar rim reduction should be done from the inside unless you have severe alar rim redundancy; the inside technique allows for avoidance of external incision lines which can often not heal optimally.

David Alessi, MD - Account Suspended · Answer

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.

Richard W. Fleming, MD (retired) · Answer

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.

Michael Elam, MD (retired) · Answer

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.

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