What would be the best method for alar base reduction? Wedge excision, or Sill excision? (Photo)

The Ala or Nostrils can be reduced in the size, the amount of flare, or both depending upon the configuration and overall size of the nostrils.   The kind of reduction is determined by the surgeon's design of the excision.  From your pictures it appears you need both size and flare reduction.   This is usually done in combination with a rhinoplasty but can be done as a stand alone procedure under local anesthetic for patients who are just unhappy with their nostril shape or size alone.

The technique chosen for the alar base really depends upon what your goals are.  Variations treat the sill or base or both.

 An alar plasty is performed to narrow wide nostrils by placing an incision along the nasal sill and removing a wedge of skin and closing the incision which narrows the nostrils

 Both methods are perfectly appropriate for the right problem. It is not that one is better than the other, but the important question is what does the patient need. If the patient is only trying to make the base narrow  and reduce the width of the nostrils, then a sill excision will suffice. If the patient is also trying to reduce the size of the ala   themselves, then a wedge excision  maybe more appropriate. 

An alarplasty can be used to accomplish several changes with respect to the size and shape of the nostrils as well as the overall width of the nose.  How the alarplasty is designed will determine what exact changes are seen.  All the best,Dr. Remus Repta

To reduce the flare and make the nostrils more vertical, a Type III WEIR excision is usually used.You can research this term online