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

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

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include placement of extended alar contour grafts to treat alar retraction and tensioning of the tip , 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

Many thanks for your enquiry,
Alar retraction can potentially occur when the lower lateral (alar) cartilages that help to form the shape of the nostrils are reduced in size to in turn help to help shape the nasal tip. In your photos, the right side does appear to have retracted more than the left.There is a potential to lower these by adding graft material to the nostril "rims" via incisions on the inside of the nose. However, this would be better undertaken with someone specialising in rhinoplasty procedures rather than a generalist
Best Wishes