Can someone explain to me weir vs sill alarplasty? (Photo)

Question

I like my nose with the exception that my nostrils are very flared . As an African, a too narrow nose will not work with my features. Is there a way to reduce my nasal flaring while minimizing a reduction in the width?

Donald B. Yoo, MD, FACS · Answer

Weir incisions are designed along the outside of your ala or nostrils in the crease where they meet the cheeks. They are designed to reduce the flare of the nostrils and ala, and careful design and precise execution is necessary to minimize the appearance of this scar. Sill incisions are designed withn the flat portion of the nostril (nasal sill) and are intended to reduce the width of the nostrils. Proper alar base modification design is typically a blend of these concepts and must be individualized for the most natural shape. For you specifically, it does appear possible to reduce the flare of your ala without affecting the width.

Jacob Tower, MD · Answer

Hello, hope you are well. Alarplasty can be performed to reduce nasal base width, flaring, or both. All three options involve making incisions in the skin creases around the nasal base. Reducing flare alone would require excising crescents of the nasal ala, whereas reducing width involves removing wedges of tissue from the nasal sill (violating the nostril margin itself). One can be performed without the other, or a combination excision can be performed. 
Best,Dr. Tower

Tanveer Janjua, MD · Answer

Alarplasty:
Alarplasty is a very fine and quick procedure that can narrow the nostrils and reduce the flare to soften the appearance. It has other names as well like ‘Weir Excisions’ or ‘Nostril Reduction’. It can be done under local anesthesia. The social down time is about a week. If you want to work from home you can start it the next day. For the procedure you are evaluated to determine how much of a change is needed. In the past surgeons had recommended 2mm to 5mm reduction. This was measured by drawing a vertical line at the lateral sides of the nostrils (alae). However, I prefer to use a mirror and Q-tips to show the patient how much of a change can be accomplished. Pushing with Q-tips from the sides can mimick the change. Patient can also pinch their upper lip near the base of the nose and will show them how much narrowing to expect. I try to quantify the change as small, medium and large. Rarely it can be extra large as well. I always advise the patients to be conservative in the change as it is an irreversible procedure. The procedure historically did not get a lot of attention in plastic surgery. It was always thought of an adjunct procedure done with a rhinoplasty. Historically most ethnic groups did not get rhinoplasties. Hence, the caucasian rhinoplasty was the main procedure that plastic surgeons were trained on. 15 years ago I started making videos on the procedure and putting them on YouTube. In my blogs I started using the term 'Alarplasty' as most doctors and patients were using the term nostril reduction or Weir Excisions. I started noticing that over years the term 'Alarplasty' became popular among patients as well. Today, most patients use the term freely and know a lot about the procedure. I am very excited to see this evolution over the years. My African American patients were especially happy to learn that you can make the nose look small without having to do a full rhinoplasty. Many of them noticed that every plastic surgeon they went to offered a full rhinoplasty. 
In summary, Alarplasty is a unique procedure in itself and hopefully more surgeons get trained in it and help more people.
You can visit our alarplasty website to learn all about it. 
Click on the video link below to see the details.
Regards
Dr. J

Can someone explain to me weir vs sill alarplasty? (Photo)

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