Technique of Alar Wedge Nostril Narrowing

Rhinoplasty can change most features of the nose through well known bone and cartilage manipulation maneuvers. There are very few soft tissue procedures that can be done to make nasal shape changes. The one nasal shape soft tissue change that can be done is that of the nostrils.
The shape of the nostrils is controlled by a variety of tissue supports. The upper part of the nostril’s shape is determined by the lower lateral cartilage and soft tissue triangle. The base of the nostril is supported by the nasal sill skin and the bony support of the bony pyriform aperture. The side of the nostril is influenced by the lower lateral cartilage, skin and the bony pyriform aperture side wall.
Nostril narrowing is done through a soft tissue excision. It is often done as part of many rhinoplasty surgeries and more rarely done as an isolated procedure. It is used to narrow the interalar distance between the side of the nostril and the columella as well as reduce the thickness of the nostril.
The most common form of nostril narrowing is commonly referred to as Weir wedges. This is where wedges of skin are removed from the nasal sill skin from the inner edge of the side wall of the nostrils. Like the name implies these are wedges of skin, usually about 4mms in width, that are removed in a diamond-shaped pattern. By closing the excision site the nostril side wall is brought in.
While an excision of 4mms may not seem much, when done on both sides that is a nostril narrowing effect that is almost 1 cm. This can be very substantial in the relatively small size of the nose compared to the rest of the face.
Nostril narrowing can also effect how the tip of the nose appears. When the nostril width becomes more narrow the tip of the nose can appear wider. This must be considered when the procedure is done by itself. Since nostrils can not as easily be made wider, it is important to make sure that it is not overdone.
Dr. Barry Eppley
Indianapolis, Indiana