Why do some doctors remove the nasal sill and can it be replaced?

Tissue is usually only removed from the nasal sill in order to narrow the base of the nose. If you have an objectionable scar in that area it can be revised. If your nose has been overly narrowed you likely would require tissue to be replaced in that area with a soft tissue graft. Seek a consultation for more specific advice from a rhinoplasty expert. You want to ensure that you meet with a surgeon who does alot of alar base reduction as many surgeons do not have much experience with this specific modification of the nose and it can be tricky. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

The nasal sill is where the soft tissue of the nostril meets the upper lip skin.  A wedge of tissue can be removed from the nasal sill to narrow the nostril opening and decrease the overall width of the nasal base.  This is an important component of rhinoplasty in patients with the previously described nostril anatomy, and is particularly common in ethnic rhinoplasty.  As a general rule, the lateral extent (outside edge) of the nostril should line up with the medial canthus (inner corner of the eye) with a vertical line drawn down the face on each side.  If the nostril extends outward beyond this line from the inner corner of the eye, the nostril will likely benefit from narrowing.  If the nasal sill is over resected (too much tissue is removed), the only way to replace it is by recruiting additional soft tissue; this would typically be in the form of a graft or flap.  In general, care is taken to avoid over resection of the nasal sill during a rhinoplasty, as we can always easily remove more tissue, but putting it back is much more difficult.
Ziyad Hammoudeh, MD