In patients requiring minimal alar reduction, excision of a wedge of epithelium and soft tissue from the nostril floor only (Fig. 1) will slightly reduce the alar flare by reducing the dimension of the internal (medial) border. Although the outward curve of the ala is altered, no medial repositioning of the alar-facial junction is effected. The scar is effectively hid – den within the nostril floor if the nostril sill is not violated. At times, the shape of the nostril sill will determine whether this approach is appropriate. Subtle, conservative, but effective improvements are possible with this approach. The dimension of the lateral alar border remains unchanged.

Figure 1. Internal nostril floor reduction will slightly reduce alar flare. WEDGE EXCISION OF NOSTRIL FLOOR AND SILL

Further reduction of alar flare is accomplished by carrying the incision across the sill into the alar facial junction 1 mm to 2 mm above the alar facial crease. Reduction of flare as well as slight reduction of the alar hulk is effected (Fig. 2).

Figure 2. Wedge excision of nostril floor and sill conservatively reduces flare as well as alar bulk.