Line down middle of nose along with asymmetry, why is this happening? (Photo)

Question

I started using great skin care. Now I’m noticing a distinct line down the middle of my nose. The skin on the right side seems raised and almost a different color. Tip of my nose on right side is also more prominent. Never noticed this before. Why is this happening!?

Donald Groves, MD · Answer

Hello and thank you for your question! It sounds like your primary concern is the shape, poor definition, and asymmetry of your nasal tip—one of the most common reasons people seek out both primary and revision rhinoplasty. This is mainly due to the underlying anatomy of the structural framework of your nose (made of bone and cartilage). Your new focus on skincare might be making your nose shape more apparent. If you'd like to improve the appearance of your nose, your specific issues can only be properly addressed through rhinoplasty.

Many surgeons overlook key techniques that can otherwise soften the appearance of underlying structures in the nose, especially in patients with thin skin (such as yourself), significantly improving tip symmetry and refinement. These specialized maneuvers require a high level of expertise and experience, which most surgeons simply do not have. Given your history, an open septorhinoplasty would be the best approach to precisely reshape your nasal tip, refine the bridge, and restore overall balance.

In addition to reshaping your nose aesthetically, your septal cartilage (or an alternative graft material) would be used to create structural grafts, reinforcing key areas like the columella (the strip of tissue between your nostrils). This is crucial to maintaining long-term symmetry and preventing future distortions.

Rhinoplasty is one of the most technically demanding procedures in all of plastic surgery—millimeters make all the difference. If a surgeon is only performing one or two rhinoplasties per month, they simply do not have the level of experience necessary to achieve the best possible result. Your nose defines your entire face—this is NOT a surgery to leave in the hands of just anyone.

I have had extensive training in complex rhinoplasty, working under one of the highest-volume rhinoplasty surgeons in the world (who performs 1,000+ nose surgeries per year). If you’re serious about getting the best possible result, I’d be happy to see you for a consultation (Virtual or In-Person) where we can discuss your goals, perform a detailed examination, and create a customized plan for your ideal nose.

I look forward to helping you achieve the refined, balanced nose you deserve!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Eric M. Joseph, MD · Answer

When people have thin skin, it is common to see a visible cleft in between the right and left nasal tip cartilages. This tends to become more prominent with aging and loss of facial volume. If someone's nasal tip is not too wide, this appearance can sometimes be camouflaged with microdroplet Silikon-1000. Since you appear to have somewhat of a wide tip appearance, the feasibility of fillers may not be reasonable. You may wish to consider rhinoplasty surgery if this is causing a lot of dissatisfaction. Wishing you well. Sincerely Dr Joseph

Steven M. Denenberg, MD · Answer

You have a milder version of the wide tip cartilages in the before and after photo I posted with this answer. The two cartilages that form the tip of your nose are broad and strong, and they make the tip look wide-ish. When the tip cartilages are like that, you can often also see the little dent between the cartilages where they meet in the middle. If you like the new skin care, don't stop using it.

How to correct the line? It would actually be quite difficult, if you like the rest of your nose. If you were to have a rhinoplasty to narrow the tip, the line could be corrected at the same time. But to *only* correct the line -- it wouldn't be worth the risk of a big operation, imo.

For the sake of this answer, if we assume you would like to narrow the tip and remove the line, how *much* to narrow the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs -- complicated work on the tip cartilages -- require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

Anna Chacon, MD, FAAD · Answer

Microneedling is a dermatological procedure that can help with issues like scars, wrinkles, and uneven skin tone. It works by creating tiny punctures in the skin, which triggers your body to produce more collagen and elastin to heal the wounds, ultimately rejuvenating your skin.
However, whether microneedling can correct the linear indentations on your forehead depends on several factors, including their depth and cause. If the indentations are due to volume loss, treatments that restore volume, such as dermal fillers, might be more effective. If they're due to vascular issues, other treatments may be required.
Remember, it's essential to consult with a professional dermatologist or a cosmetic surgeon who can examine your skin and provide a more accurate assessment. They can offer you the best treatment options based on your skin type, the nature of the indentations, and your overall health.

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