Q: I have had an overaggressive weir excision to my nostrils, causing my nose to look unbalanced. I also have difficulties breathing as my nostrils are always flaring. I have read your website and other studies with regards to fixing the problem with concha cartilage. In your opinions, is that a feasible option aesthetically or will it result in unnaturalness? I am wondering if I should just live with it and flare my nostrils all the time or get it fixed. It is impacting me very much emotionally as well. But I don’t want to end up like Michael Jackson with no nose.
A: The removal of skin from the inside of the nostril where it comes down and joins to the upper lip is known as weir wedges. Removing skin in this area is a rhinoplasty technique that is designed to narrow the nostrils for those whose nostrils are flared, too wide, and are not in balance with the rest of the shape of the nose.
Overresection of the nasal base, or narrowing the nostrils too far, not only can give a pinched look but can cause difficulty in breathing through the nose. Collapsing the wing of the nostril (lower alar cartilage and nostril rim) can cause narrowing of the important internal nasal valve, an important area inside the nose which plays a major role in breathing.
Correcting nostril stenosis requires replacing what has been removed in the area where it has been removed. This can be done with a composite cartilage and skin graft from the ear. While this will work, one has to be aware that the graft may be slightly visible as the skin color between it and the nasal skin will not be perfectly matched.
Whether one should consider correction of nostril stenosis from a prior rhinoplasty or injury depends on how severe the nasal breathing problem is and how unbalanced the nose looks. If both are significant, then I think it is reasonable to undergo it.