What is the Difference in Outcome Between a Sill Reduction and an Alar Base Reduction?

Question

Does one technique decrease the nostril width more and make the overall base of the nose appear thinner? Also, is it popular to do a combination of both?

Anita Patel, MD, FACS · Answer

That is an excellent question, and highlights the difference between alar flare and the alar base. There are three components when talking about alar base reduction, and these are the nostril sill, the alar insertion, and alar flare. The nostril sill is the flat part of the base, located on either side of the columella. The alar flare is the rounded and/or flared portion of the ala. The alar insertion is where the ala meets the face. Some patients have flared nostrils but a normal alar base, and in this case reducing the alar flare without further narrowing the base is appropriate. Other patients have a wide base but do not have flared nostrils, and in these cases reducing the sill and/or part of the ala is appropriate. Some patients have both flared nostrils and a wide base, and in these patients usually a sill reduction and alar reduction is appropriate. When people talk about an alar base reduction, it can refer to any combination of the above. What is popular is irrelevent, because what would be best for you may not be best for someone else. Also, there are many ways to reduce the alar base, and some techniques leave more noticeable scars than others. It is really important to consult with a board certified plastic or facial plastic surgeon who has experience doing alar base reductions, and ask to see photos of the scars. You can also ask the surgeon to draw on you where the incision would be and what part would be removed. When done poorly, alar base reduction can leave obvious scarring, abnormal appearing nostrils, pinched nostrils, bowling pin deformity, or Q-deformity. These deformities are difficult to fix, so while it is considered a "simple" procedure, it only looks good when meticulous technique is used.

Rod J. Rohrich, MD · Answer

Alar base reduction can reduce nostril size and shape depending on the extent of the scar versus the extent of what needs to be done. Alar base sill reduction reduces the width between the alar bases and this can have a significant change in the width of the nose.

Ronald J. Edelson, MD · Answer

There seems to be some confusion over exactly you want done. You should see a few different plastic surgeons and have them draw out on your nose exactly what they would do. This surgery involves artistry and experience and the selection of the right surgeon will be the most important decision you make. God luck!

Toby Mayer, MD · Answer

Weir nostril reduction incisions decrease the nostril width and you should not see the scars.

Tanveer Janjua, MD · Answer

Alarplasty is the standard technique which some times extends into the sills as well. Sill reduction alone can narrow the nostrils inner diameter and affect the breathing. Alarplasty would be my choice.

	Regards

	Dr. J

	Disclaimer: This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

Kenneth Hughes, MD · Answer

Alar base reduction occurs at the base of the ala, and the sill reduction occurs along the floor of the nostril. You can use a combination, but alar base reduction can be camouflaged well in the groove. Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Kimberly Lee, MD · Answer

Alarplasty or alar base reduction refers to reduction of the nostril base. When you refer to sill or weir, this refers to the actual technique that is used. It is best to focus on the result you are seeking and allow your board certified specialist determine which techniques will help you achieve the results you seek. Computer imaging will be helpful in allowing you to see what you may look like afterwards.

Kristina Tansavatdi, MD · Answer

Both a sill reduction and an alar base reduction can narrow the width of the nose. However, an alar base reduction also gives the advantage of taking away nostril flaring. How do you know if you have nostril flaring? Take a picture of your nose from the bottom of your chin looking up. Then analyze where the flesh of your nostril meets your face. If you draw an imaginary perpendicular line up your face from there and it hits any of your nostril then you have some nasal flaring. An alar base reduction by itself or in combination with a sill reduction to get additional narrowing is most common. A sill reduction alone is least common. Your surgeon can also perform a V-Y advancement if the alar base and sill reduction are not enough to achieve the desired result.

What is the Difference in Outcome Between a Sill Reduction and an Alar Base Reduction?

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