Breathing Problem and Uneven Nostrils After Rhinoplasty?

Having some problems breathing out of my right nostril and it feels like the inside is real low. Also I know my nose is still swollen it's only been a month after Rhinoplasty, but the right nostril looks like it sinks in to much. Will the left side go down to match the right? Will my nose look pinched? What do you think?

Doctor Answers 9

Your instincts are *probably* correct.

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While it's difficult to tell for certain at this stage, asymmetries are almost never normal at this point. Swelling, tip definition, rotation, etc.--those all change during the early stages. But I don't think that any of my colleagues would suggest that marked asymmetry is to be expected a month out.

So the question then becomes what to do about it. The short answer is probably to wait. Not because I think the asymmetry will disappear, but because the degree of asymmetry may lessen some with time and any touch-up procedure can then be more limited.

In the meantime, though, it's critical to have a frank discussion with your surgeon about this to get an accurate diagnosis (something none of us can give you with just a picture and no physical exam). There may be some sutures that can be released (e.g., a misplaced skin suture at the marginal incision or intercartilagenous incision--doubtful but possible). There may be a deviation of the septum or turbinate congestion that's adding to the breathing difficulty. Heck, there could even be a band of scar between the septum and lateral nasal wall that's creating this (unlikely). Anyway, a lot of possibilities exist.

Work with your surgeon. Get a second opinion (in real life, not just virtually on a message board). Stay positive and don't rush into anything.

All the best,


Jacksonville Facial Plastic Surgeon

You're still very swollen

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Since it has only been approximately a month after your surgery, your nose is still swollen. It takes a full year for the final healing process to take effect. It appears that the nose is more swollen on the left side than the right, which may indicate either swelling or cartilage in the nose, and breathing will start to improve over the next couple of months, although slowly. The nostrils are always slightly asymmetrical to start with and are never perfectly symmetrical on anyone’s nose.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Wait and recheck after Rhinoplasty

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After viewing your photograph I wonder if this is still inflammatory swelling or some sort of structural asymmetry. If you do not have an infection causing the swelling, you will have to wait for the tissues to settle a little longer. It certainly bears watching and rechecking.

I would like to see your preop photographs also.

A few general points about asymmetry.

First, no person is perfectly symmetric. Every person has "some" facial asymmetry and perfect symmetry after rhinoplasty is an unrealistic expectation because everything that supports the nose upon the face is slightly asymmetric. Many patients will note that their nose looks a little different when looking at themselves from a right vs left angled view. This is entirely normal.

Second, it is not unusual to have some asymmetry from post surgical rhinoplasty swelling; your swelling looks like a little more than I normally see.

Third, swelling can come from infection, tissue trauma or the underlying structural support.

I certainly hope there is no infection. If that case, it may be good to allow the tissues to recover from surgery. Talk to your doctor and see what he thinks. Usually, if a doctor becomes puzzeled over an issue he/she will consult colleagues on a case. That might be a good start. Then you can get second opinions if you feel that is necessary.

Phillip Langsdon, MD
Germantown Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

One month is too early to judge Rhinoplasty results

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As you are already aware, there is a substantial amount of swelling after a Rhinoplasty. The swelling takes several months to improve. In general, it would be about 6 months before one can accurately talk about the result. As Dr. Persky mentioned, your right lower alar cartilage could be causing you breathing problems due to external nasal valve collapse. Hopefully that will improve with time. Good luck.

Sirish Maddali, MD
Portland Plastic Surgeon

Rhinoplasty...Breathing Problems and Nostril Asymmetry One Month After

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Hi Kerry,

It is still too early after your rhinoplasty to judge how things will eventually turn out. It does appear that your right lower lateral nasal cartilage is pinched showing signs of external valve collapse which would effect your breathing on that side.

Stay in close contact with your rhinoplasty surgeon. After 6 to 12 months your nose can be more accurately evalutated. I hope that as your nose heals your breathing improves, and that it is symmetric.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Give it some time

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Certainly only one month after surgery the nose is still going to be swollen and things are going to change. If the nose was symetrical right after surgery, then the chances are good that it will end up symetrical. Unfortunaetly it takes about a year for everything to settle down before you will see your final result. About 15% of rhinoplasties require some sort of revision. Do not re-operate on it before a year or it could make things worse.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.8 out of 5 stars 46 reviews

You'll have to wait until at least a year has gone by.

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It is too early to tell how your nose will finally look. It is still swollen from surgery. I have noticed in most patients that the left side of the face stays swollen longer than the right before correcting. You may need to get an evaluation by your surgeon with regard to the breathing difficulties. If you had certain predispositions to having airway narrowing problems prior to your rhinoplasty and these predispositions were not taken into account at the time of your surgery, you can develop problems after surgery. Go see your surgeon and let time progress to see what happens.

Good luck.

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 69 reviews

Nose asymmetry one month after Rhinoplasty

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Dear Kerry,

I agree with the other two docs. You have obvious swelling, and it's too soon to judge your final outcome. Keep following up with your surgeon so he can make appropriate recommendations as things settle down.

Goos luck, and best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Too early to tell

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The ultimate result is a balance among the various influences on nasal shape which include: sacr tissue, bone, cartlilage, surgical (stitches or grafts).

Scar tissue forms for at least 6 weeks after any surgery making it difficult to predict the ultimate outcome.

In the nose the cartilaginous forces also play a role and can change with time.

A mild amount of asymmetry in the nose is considered normal.

Given these considerations, it is nearly impossible to guess the long term appearance of the nose. Certainly the breathing situation can change as well and will vary with allergies, time of day, and healing.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.