Intraoperative views of alar wedge and sill excisions. A, Both alar flaring and sill excess are present. B, Open rhinoplasty is performed with increased tip projection and a modest change in the nostril shape. C, Incisions are placed to remove flare and to enter the nasal sill medially to the alar insertions, preserving the lateral ala. On the patient’s left (C), flare and sill excisions have been carried out, and markings show the planned excision on the patient’s right. The oblique marking line (C) is useful for realigning the alar segment after the sill excess has been removed. D, Flare and sill reduction are completed bilaterally.
Comments: Although the client seems to be liking nose with small Alar Base(pic D), but in my view, his nose was better off with only tip reinforcement leaving alone the wide alar base intact, i-e, nose as shown in pic B. In the pic B Nostril size is in proportion with the mass in reinforced tip. Compare pic B to the view in pic D where tip vs nostrils size proportion once again is out as it was origionally in pic A.