Alarplasty: weir vs sill excision (Photo)

Question

I am looking into having alarplasty in the hope of reducing the width of my nose and have been looking into the difference between weir excisions and sill excisions. The thing is, my nostrils aren't flared but just wide set, which is why I'm wondering if a weir excision would be effective at all? I have attached a simple illustration to help explain what I mean - via weir excision, would this nose only be able to be reduced until the black vertical line (where the base of the nostril is)?

Ronald J. Edelson, MD · Answer

There are many different types of alar wedge resections.   Performing a good alar wedge resection requires experience as well as an artistic sensibility.  Look at photos of rhinoplasty with alar wedge resection when you go on consults and you will be better able to make your decision.

Toby Mayer, MD · Answer

You would be better off with weir incisions which are beneath the nostrils. This scar has healed without need for revision for my 35 years of rhinoplasty. The incisions on the outside of the alar sills rarely heal well and patients always wish they never had them.

Jason Roth, MBBS, FRACS · Answer

The Weir incision line can be extended all the way to the sill. The nose can be reduced more than the vertical line you have illustrated by simply removing a larger wedge. It does not appear that a sill excision would be necessary and this should be avoided.

Thomas Trevisani, MD · Answer

I basically understand your concern. There are several issues to address: 1- the bulk of tissue at your alar groove can be reduced without transacting the internal alar rim. That may give you the narrowing you seek. Often times- we are faced with an unacceptable circumference or curved length of the internal nostril rim. This can be reduced by a type of excision that parallels the rim without transacting it. In any case- I'm opposed to a scar that transacts the internal alar rim- which will most likely produce a notch, a tell-tale sign of nostril intervention.

Myriam Loyo, MD · Answer

Hi there, The main difference between weir and alar sill excisions is the location of the scar. As you know, alar sill excision reposition the ala and bring it to the midline by removing tissue from the nasal sill which creates space medially. In alar sill excisions,  the scar is in the undersurface of the nose. Weir excisions remove the extra fullness in the ala by excision the tissue in the ala laterally. The scar in Weir excisions extends laterally in the junction between the cheek and the ala.I personally prefer alar sill excisions when I feel like I can obtain a good result without extending the incision laterally because I feel there is less risk of the scar showing.hope this helps!

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

Sill excision refers to excision of the alar side/nostril base which is positioned to appropriately reduce alar flaring,etc. This is the most effective means of reducing alar flaring, improve symmetry (you actually have some symmetry which can be corrected with this technique, and to do so while hiding in the incisions on the inside of your nose instead of the outside(WEIR).

Richard W. Fleming, MD (retired) · Answer

I always prefer an alar sill excision when narrowing the nasal base because there is less risk if an unfavorable scar. I think the alar sill excision would work for you but the advantages and disadvantages of each can be shown to you during consultation.

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