Off-Centered Columella and Uneven Nostrils

After my first rhinoplasty over a year ago I have an extremely asymmetrical nose. The nostrils are completely uneven and the columella is off centred. What can be done to make it symmetrical and even?

Doctor Answers 9

Off centered columella and nostrils

Having had a lot of experience in this kind of revision work I can tell you that this is a very difficult problem to correct. Much more so that most surgeons and patients think. The problem can be one of three things or a combination of all. 1) the caudal septum may be deviated more to one side than the other pulling the columella with it and making the nostrils assymetric. This would be the best senario and the easiest to correct. 2) The lower lateral cartilages have been poorly resected in the first surgery and have healed in an assymetric fashion. 3) there may have always been some assymetry to the nostril sizes that wasn't noticed or made apparent until you had the rhinoplasty......However your particular problem may be any combination of the above....go see someone who has the experience and skill to sort this out and correct it, if not you'll be chasing your tail forever.

Miami Facial Plastic Surgeon
4.6 out of 5 stars 11 reviews

Tip and nostril asymmetry

At this point you will need a revision rhinoplasty +/- septoplasty to improve the asymmetry - the good news is that there is room for improvement

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Crooked nose

There are several reasons for crooked nose. From your picture, it appears that one obvious reason is deviated septum to the left and is pulling the lower part of your nose to that side. Septal reconstruction should correct this problem.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon
4.6 out of 5 stars 12 reviews

Uneven Nostrils

The best photograph for this problem is the so-called "worm's-eye view" taken with your nose pointing up toward the ceiling. In addition, you did not say whether you had uneven nostrils before your first surgery or if you had nostril reduction surgery at that time.  That being said, usually uneven nostrils is due to a deviated caudal septum.  The best treatment for this is straightening of the caudal septum.  If you had Weir excisions and the alar lobules are uneven, then a revision of the nostril reduction surgery is required. 

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 45 reviews

Off-centered columella and uneven nostrils

An off-centered columella is often due to a deviation of the caudal (anterior most part) septum which pulls the columella along with it. An in depth examination would be in order to better determine the cause. With revision surgery the asymmetry should be correctable, however.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Deviated Columella and Asymmetrical Nostrls

A deviated columella is frequently secondary to a deviated septum, which can be  corrected with surgical intervention. The sharp vertical lines in your tip may indicate tip collapse, which also can lead to nostril asymmetry.  If that is your problem cartilage grafts will be necessary. Although perfect nostril symmetry is not necessary, consult with an experienced rhinoplasty surgeon to discuss your options. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Two Problems. Separate Solution for Each

Hello, Thailand friend.

The off-center columella is usually such because the front part of the septum is not in the midline. That requires surgery, although it is not complicated and takes less than half hour.

The nostril assymetry may be due to prior nostril narrowing and if so, surgery will be needed to create a better match. In your case, that seems the case. Your right ala or lateral nostril wall sits higher on the face than your left. 

While some nostril asymmetries can be corrected with fillers, those best suited for that technique are nostrils that have the top or peak elevated more than ideal. The fillers are placed through the skin to fill and " drive down" the edge.

Suggest consulting with a specialist with long experience doing noses.

-Robert Kotler, MD, FACS

Beverly Hills, CA

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 85 reviews

Correcting nostril asymmetry

It may be possible to either advance your nostril inferiorly or bring up your columella depending upon the position of your other nostril as well as whether or not the higher nostril is retracted or not. I would seek the advice of a rhinoplasty expert before proceeding.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Asymmetric nostrils

No two nostrils are exactly the same.  There will be some asymmetry. As  for the columella tipping to one side, I would need to perform an exam to figure out what is the issue.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 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.