Dear Caseykemmerling, thank you for your question. Correcting nostril asymmetry is commonly carried out during primary rhinoplasty, there are a number of different causes for such deformities. Most commonly this is a result of three underlying problems. First, congenital deviation of the front portion of the septum can change the shape of a nostril. Secondly, congenital asymmetry of the lower lateral cartilages can also lead to these types of issues. Lastly, the actual size of the nostril can be uneven if there is excess soft tissue within the nostril causing an asymmetric size to the nostril opening. A detailed examination of the tip of the nose will reveal what solution would be most appropriate. It is therefore important to include possibly a septoplasty, a tip plasty and/or alar plasty as part of the surgical solution depending upon which issue is present. Best wishes, Dr. Tobias