Single-nostril alarplasty for small asymmetry? (Photos)

Question

Over time I developed an asymmetry in my nostrils. One is slightly wider, more open and looks wider than the other side when I smile. How effective/risky is doing an alarplasty to fix such a small asymmetry? Could it make the asymmetry worse? What about improving the symmetry when smiling? One surgeon said it can be improved, one said not to bother, it could make it worse. I do have a deviated septum but I am not planning to get a septoplasty. It looks worse in photos than in real life.

Michael A. Persky, MD · Answer

Hi JB,
If it's not broke, don't fix it.  Anytime that you have any surgery there is a possibility of making something worse.  Your complaint is extremely mild in photos, and less so in real life.  The only time to consider doing a correction would be if you were having septoplasty, then you might address it at the same time.  It is not a "minor" procedure.  Good luck and be well.
Michael Persky, MD
Encino, CA

Ronald J. Edelson, MD · Answer

I’ve never seen a one sided alarplasty work out well so I wouldn’t recommend it. Either do both sides or not at all

Tanveer Janjua, MD · Answer

It is almost impossible to achieve nostril symmetry. Any attempts can lead to taking too much off one side and then going back to take some more from the other side. As this goes on permanent scarring with poor healing can lead to worst asymmetry than before the surgery was done. 
Also, it is very important to remember that nobody will look at your nostrils from below. From the front view the nostrils don't look as asymmetric as from below. Unless the asymmetry is really obvious and disfiguring, it should be left alone.

Regards
Dr. J

Robert Ciardullo, MD · Answer

One sided alar plasty: if one nostril is larger at the base then the other it is theoretically possible to do a one sided Alar plasty to reduce the width of the base of the larger nostril. This is possible if the only discrepancy is the width at the base. If the shape of the nostril is different or there are other aspects of the nostril such as its height then the discrepancy will not be fully fixed. Care must also be taken to reattach the nostril in a way that mimics the attachment on the on operated site. So it would have to be examined to make sure that the only difference is a base width difference and care would have to be taken to match the shape to the contralateral side, As well as the width. It takes some planning and needs nearly flawless execution. There is the possibility that it will create other asymmetries that are as bad as the first. So some would recommend against it but if the difference between the nostrils is very obvious and is only due to base width discrepancy, a one sided nostril tuck, well executed should be an overall improvement but would not be a perfect match. Then again no two nostrils are an absolutely perfect match if you look close enough

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Afternoon! Asymmetry in the nostrils can be tough to treat. You could do a unilateral alarplasty to improve the symmetry. Sometimes, the nostrils are asymmetric due to "push" from the septum being deviated. Therefore, an internal exam to ensure this isn't an issue would be worthwhile. Doing an alarplasty can make the asymmetry worse if not done correctly and in a subtle way. It will likely limit the excursion with smiling but not entirely. Hope this helps you!

Single-nostril alarplasty for small asymmetry? (Photos)

Answers (5)

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