I want my nose to look less flared but very natural and not pinched. Should I get a weir or sill method? (Photos)

Question

I want my nose to look less flared but very natural and not pinched. Should I get a weir or sill method?

Semih Yildiz, MD, FEBOPRAS · Answer

The frontal and basal photos show a broad alar base with rounded nostril contours and some lateral flare, but the angles are not standardized enough to choose an incision pattern precisely. A Weir-type wedge primarily reduces lateral alar flare. A sill excision removes tissue from the nostril floor and is more useful when the interalar distance or sill itself is wide. Many patients have a combination, and a small customized reduction in both areas can look more natural than an aggressive single excision. The amount removed matters more than the label. Over-resection can create pinched nostrils, notching, asymmetry, visible scars, or airflow restriction, and lost tissue is difficult to replace. Your surgeon should measure the alar base at rest and while smiling, assess tip and columella position, and mark the proposed excision while you are upright. Ask to see healed results in patients with similar skin and nasal-base anatomy. A conservative first-stage reduction that preserves the natural alar curve is the safer way to pursue the subtle change shown by your goal.

Eric M. Joseph, MD · Answer

The Weir excision involves leaving a scar between your nose and cheek, and in our experience, these scars can remain visible and unsightly. Since you appear to have a wide, broad, and flat nasal appearance, with relatively thick skin, please consider visiting several reputable rhinoplasty specialists so you can see what to achieve. I say this because I suspect you would require more than nostril narrowing. Full nasal narrowing, with a sill excision would be our preference. I hope this helps. Sincerely, Dr Joseph

Mark Beaty, MD · Answer

Alarplasty is an excellent option for reducing nostril flare while preserving the natural shape of your bridge and tip. The specific technique will depend on the surgeon’s approach and your individual anatomy, and in many cases, a combination of both methods may be used to achieve the most natural result.

This procedure is often performed in-office under local anesthesia. The best next step is to consult with a board-certified plastic surgeon or facial plastic surgeon who frequently performs alarplasty, as they can evaluate your nasal structure and recommend the most appropriate technique for your goals.

Tanveer Janjua, MD · Answer

You will need an alarplasty to narrow the nostrils and reduce the flare. It will be a combination of Sill excision and wedge excision of the nostrils at the same time. It is not as much about the method but the surgeon performing it. You need to do your research and then decide. 
If you want to maintain your ethnic look then you don't need a full rhinoplasty. 
Regards
Dr. Janjua

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a rhinoplasty. A surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

I want my nose to look less flared but very natural and not pinched. Should I get a weir or sill method? (Photos)

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