Asymmetry and alar retraction - What is the least invasive procedure to fix issues and make it aesthetically pleasing? (Photos)

Based on your photos, you are a great candidate for revision rhinoplasty. The tip droop needs to be lifted, which helps columella show. The tip is also too wide, and this can be refined during a revision, while trying to push the nostrils down at the same time. Be sure to see an expert rhinoplasty surgeon for consultation.

At this stage—several years post-op—it's understandable that you're reassessing your results and noticing details like alar retraction, columellar projection, and asymmetry. These concerns are relatively common after rhinoplasty and can often be improved.
Is the asymmetry very noticeable?Photos can help, but even with those, a definitive judgment requires an in-person evaluation. Minor asymmetries are quite common and often not obvious to others. That said, even subtle differences can feel significant to you—and your concern is valid.
Least invasive options to improve appearance:Filler (Liquid Rhinoplasty): In some cases, hyaluronic acid fillers can be strategically placed to balance minor asymmetries or camouflage mild alar retraction. However, this is a temporary solution and less effective for structural issues like significant retraction or columellar over-projection.
Alar Retraction Correction (Cartilage Grafts): If retraction is more pronounced, composite grafts (typically from ear cartilage or soft tissue) are often used to restore contour. This would require revision surgery but can be tailored to be conservative.
Columellar Adjustment: Columellar over-projection is usually corrected with revision rhinoplasty, adjusting cartilage support. A subtle revision focusing only on this area might be possible if the rest of the nose is stable.
Since you’re seeking the least invasive approach, a good first step is a consultation with a surgeon experienced in revision rhinoplasty. They can assess whether a nonsurgical option is appropriate or if a limited surgical revision would offer better, lasting results.
I hope this helps guide your next steps. A personalized evaluation will provide the clearest path forward.
— Güray Yeşiladalı, MD