Is it normal to place a graft on only one side of nose tip? How can I improve asymmetry? (Photos)

Question

I’m 11 months post op from primary rhinoplasty. I have a graft in the left side of my tip. That nostril is higher and pointier than my right one, which has a more natural shape. Asymmetry is very obvious when I smile. I’m just wondering if it’s normal to place a graft (cseg I believe) on only one side and if nostril asymmetry is an expected result. What would you advise if I wanted a revision to make this issue better? I won’t do an alarplasty on my right, more natural-looking nostril. FYI my before nose was crooked at the tip but nostrils were symmetrical when I smiled. My surgeon said my cartilage was very brittle and I don’t think she had as much usable cartilage to use as she thought she would.

Eric M. Joseph, MD · Answer

Based on your photos, I would strongly advise against another rhinoplasty surgery. At least, keep it as a last resort. I can see that you left nostril margin is a bit higher than you're right. Depending on your examination, microdroplet Silikon-1000 injections may be considered for lowering the left nostril margin, and improving upon the symmetry of your nasal base. Thank you so much for your question, and I hope this is helpful! Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a revision rhinoplasty With nasal tip deprojection and placement of a mastoid fascia tip graft to help improve your tip contour. 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

Steve Laverson, MD, FACS · Answer

Although you evaluate the result by looking straight at it in mirror or photos from the same level, a better understanding of exactly what's going on begs for basal views, photos from beneath the nose looking up at nostrils.  Grafts, alloplastic implants (porous polyethlene), specially designed skin excisions and/or rearrangements, filler injection, and other measures may be applied to adjust nostril size, shape, position, and symmetry.  These can be challenging problems and sometimes more than one treatment or solution is required for a satisfactory result.

Is it normal to place a graft on only one side of nose tip? How can I improve asymmetry? (Photos)

Answers (3)