Uneven upper lateral cartilage on a thick skin, bulbous nose. What should I do? (photo)

I see the asymmetry you're talking about. The asymmetry is exacerbated because of the width of your nasal bones (which make the bump on the bridge in the 3/4 view, like the 4th posted photo), and because of the width of the tip of your nose and the length of the nose. It's certainly possible that the asymmetry is because your septum along the bridge is off to your right side, but a septoplasty wouldn't correct the asymmetry, and an asymmetric width to the tip cartilages could be participating, too.
If you like the other features of the nose, and only want that asymmetry that you've noticed corrected, then you shouldn't have surgery, and you should just try to ignore it. Surgery to correct just that isolated issue is very unlikely to succeed, and it will almost certainly result in some other asymmetries or problems that you like less!

Based on your photos, you may not have very thick nasal skin. I believe some of the asymmetries that you are seeing are due to having relatively firm nasal cartilages. Depending on your examination, rhinoplasty may be considered for achieving a narrower straighter, and more symmetrical nasal appearance, along with a more pleasing nasal profile appearance as well. I hope this is helpful, and thank you for your question. Sincerely, Dr Joseph

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers.
. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

A closed rhinoplasty approach can accomplish your goals with all of the incisions placed on the inside of the nose. No external incisions are required, and no painful packing is required either. The bulbous nasal tip can be reduced by trimming back some of the lower lateral cartilages, also known as a cephalic trim. The dorsal hump can be shaved down, while still leaving it masculine. Your upper lateral cartilages will both require spreader graft placement to support them and prevent them from being concave. A thicker spreader graft will be required on the more concave side, and occasionally an onlay graft is also used. The wide nasal bones will also be narrowed with osteotomies. Rhinoplasty is the most difficult procedure to perform correctly in the entire field of cosmetic surgery, so make sure you find a rhinoplasty specialist for best results. Digital computer imaging would also help in the education process to see what your new nose would look like upon your facial features. Study your prospective surgeon's rhinoplasty photo gallery, which should be extensive with lots of natural results that you like.