Would dermal filler help even out asymmetrical nostrils? Should I be concerned about possible necrosis? 1 year post op (photo)

Question

I had revision rhinoplasty a year ago and the nostrils have remained uneven. With my follow up with my surgeon yesterday, he told me a little filler in the nostril that's showing more should even them out more rather than a surgery which would involve a graft. I would like others opinions on this as my concern is that it's a very delicate area and I worry about possible necrosis. Is filler a good option to even out nostrils?

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Alina K. Stanciu, MD, FAAO, FAACS · Answer

Fluid rhinoplasty when done by an experienced provider can help the asymmetric nostrils. Make sure you consult an experienced injector.

Nelson Lee Novick, MD · Answer

You are quite right in having concern about the use of a filler for the nostrils, especially in the nose of someone who has undergone prior surgical rhinoplasty, which leaves in its wake fibrosis and likely a change in the underlying vascular anatomy. That being said, I have personally injected the nostrils for precisely this reason using a cohesive, low viscosity HA filler with gratifying results. You must make certain however that your injector is highly experienced in performing filler injections. Remember, the training of plastic and reconstructive surgeons is in surgery, i.e. cutting and stitching. So, it might be wise to consult with an experienced, board certified cosmetic dermatologist injector. Hope this helps.

Thomas Spalla, MD · Answer

I agree with your concerns in this situation. Filler in the nose can be challenging, and when you're dealing with alar rim retraction, the area is very delicate and has a tenuous blood supply. 
The situation you're dealing with is usually caused by resection of portions of the tip cartilage and subsequent contraction and pull vertically.
Classically, the way to improve this is through rim grafting in minor situations or composite grafting in more extreme situations.

Leonard Grossman, MD · Answer

You’re probably not going to like to hear this, but most likely, your nostrils were not symmetric to begin with before surgery. However, if symmetry is what you desire most, a filler, such as hyaluronic acid may be used to create more symmetry. I hope this helps and good luck from New York City Plastic Surgery.

Would dermal filler help even out asymmetrical nostrils? Should I be concerned about possible necrosis? 1 year post op (photo)

Answers (5)

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