One side always different - can this be fixed to be more symmetrical? (Photos)

Question

I had a rhinoplasty & one side was left dented & asymetrical. Had a revision with a well versed dr but now the side that was lower is higher and still asymetrical. He improved it but imo it’s still not great. He improved the nostril asymetry but im left with two different sides. One sides transitions to the alar crease nicely but the other is a 90 angle. Internally I feel a ledge on the 90 degree one

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a revision rhinoplasty. A surgeon can accomplish this by tensioning the tip, placement of extender alar contour grafts, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Randal Haworth, MD, FACS · Answer

Yes, it can often be improved, but after a primary rhinoplasty and a revision, the goal is usually meaningful improvement, not perfect symmetry (natural noses aren’t perfectly symmetric to begin with).
What you’re describing, one side having a smoother transition into the alar crease and the other looking like a sharper “90° angle,” plus feeling an internal “ledge”, commonly points to scar tissue, cartilage graft edge/step-off, or a subtle collapse/irregularity along the alar rim/sidewall.
Common Fixes (Depending on Exam)
Minor graft refinement or repositioning (smoothing a step-off)
Alar rim/alar batten graft if there’s weakness or collapse creating a sharp contour
Scar tissue release and contour smoothing
In select cases, camouflage with a small filler can be a non-surgical option, but after multiple surgeries it must be done carefully
Timing Matters
If your revision was recent, asymmetry can continue to improve as swelling and scar tissue soften — especially in the first 6–12+ months.
Best Next Step
You’ll want an in-person evaluation with a qualified, board-certified rhinoplasty specialist who does a high volume of revision rhinoplasty. Bring:
Your before/after photos
Operative reports if available
A clear list of what bothers you (the angle, the crease transition, and the internal ledge)
That exam will determine whether this is a small surface irregularity (often fixable) or a structural support issue (needs grafting).
Good luck!

One side always different - can this be fixed to be more symmetrical? (Photos)

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