Uneven Nostrils - Can This Be Fixed?

It is not uncommon to deal with issue nostril asymmetry during a revision rhinoplasty.  It many such cases the asymmetry can be related to deviations of the tip or bottom part of the nasal septum, obviously treatment which can address or improve unevenness of the nostrils.  In some other cases there are issues with contraction of the lining of the nose, or unfavorable healing of the suture lines during the initial surgery. In any of the above cases there are standard and advanced techniques to address the particular case. On picture shown above I do appreciate deviation of the bottom part of the septum which contributes to the asymmetry, and possibly some mucosal irregularity or contraction the right side.  Revision rhinoplasty by an experienced nasal surgeon can bring significant improvement as far as this type of asymmetry, but you need to keep in mind that achieving absolute symmetry is almost impossible in rhinoplasty and your goals from such surgery should be realistic.

Unfortunately you are in good company. Most rhinoplasty patients out
there are very unhappy with their results in 1-2 years. The explanation
for this is very simple: Most surgeons performing rhinoplasty do not
have advanced training or experience, they perform the rhinoplasty of 50
years ago. Decades ago thought process of rhinoplasty was to remove
cartilage to refine the shape of the nose and perform it through an open
approach. An open approach makes it easy for neophyte surgeons to
access visualize and manipulate the structures but also unnecessarily
destroys two arteries and veins that are important for nasal
vascularity. The open approach thus ensures that patients have 1-2
years of risidual swelling which hides the final result. Most
rhinoplasties out there I consider cartilage robbing thus when the
swlling resolves there is inadequate structure to provide aesthetic
appearance and fight the cicatriacial forces or the continued scarring
that results from the lowered oxygen tension and fibrosis of tissues.
One additional problem it that most rhinoplasty surgeons out there
inadvertently break the connection between the bony nose and the
cartilagenous nose. this can cause irregular narrowing and what we
calll "the inverted V deformity" which means the outline of the nasal
bone becomes visible through the skin particularly in flash photography
under certain lighting conditions.In my opinion, an expert
level rhinoplasty is always performed in a closed technique and ALWAYS
involves grafting to add to the structural integrity of the nose. The
act of opening the nose even under the closed technique causes healing
and some contraction, thus for a long term beautiful result the nose
must be left more structurally sound than it was found. This is missed
upon most rhinoplasty surgeons. In secondary cases such as
yours it is even more crucial that sound grafting techniques are used.
It sounds like at a minimum you will needa
columellar strut but a complete L-strut and alar strut. I
Definitely do not consider any rhinoplasty procedure that does not
include grafting preferably by an experienced Plastic and reconstructive
training with ddition fellowship level craniofacial and aesthetic
training. Of course this is my bias because it is my training but I
think this level of training is very necessary for success in secondary
and tertiary rhinoplasty because there is delicate nuance involved and
every patient requires different maneuvers. I hope this helps!All the best,Rian A. Maercks M.D.

Your nostril asymmetry is at least in part due to a deviated columella +/- septum - there is also possible intrinsic asymmetry which contouring and grafting can improve