Modified Weir Wedge with Nasal Sill Step: A Novel Approach to Alar Base Reduction in Rhinoplasty

Background:

The Weir excision for management of the alar base remains a complex maneuver in rhinoplasty even for the experienced surgeon. While meant to narrow the nasal base when inter-alar distance exceeds the intercanthal distance, the concept is poorly and inadequately described in the literature. This is further complicated by the conflation of excess ala versus the nasal base width itself.

Methods:

We reviewed an array of methods for the Weir excision, including the Aufricht nasal sill excision and Bernstein V-Y advancement.

Results:

We describe the utilization of a modified Weir wedge excision with a stair step at the nasal sill in reduction of the nasal base.

Conclusion:

Narrowing of the nasal base is an irreversible maneuver in rhinoplasty but is sometimes required for appropriate aesthetic and functional results. There is a relatively high incidence of alar base reduction in revision rhinoplasty, specifically indicating that reduction efforts at primary surgery are underutilized. The modified weir wedge with nasal sill step allows for management of the nasal alar width and alar excess with one maneuver, allowing for effective and consistent results.

Funding Statement:

This submission was not funded by any entity including government funded research.

Contribution:

M.S.K.: formal analysis (lead); writing original draft and review and editing (lead); Resources (equal). M.W.R.: Conceptualization (lead); visualization (equal); Resources (equal). E.H.F.: Conceptualization (lead); Resources (equal); Supervision (equal). J.T.: Conceptualization (lead); Investigation (lead); project administration (lead).

Disclosure Statement: The authors have no competing financial or ethical conflicts of interest to disclose.

Runtime of video: 2:22