Hi jrwilson, thank you for your question, and it says something that this has stayed on your mind for forty years. The encouraging news is that isolated nostril asymmetry can often be improved at any age, and at 61 you are not too old for this kind of surgery provided you are in good general health. Forty years on, the original surgery is completely healed and stable, which in some ways makes planning more predictable than an early revision. The right procedure depends on where the asymmetry actually sits: sometimes it is the nostril rim or base itself, correctable with a relatively contained alar procedure, and sometimes the visible unevenness is driven higher up by the tip cartilages or a deviated septum, which is a different operation. Skin in our sixties is also thinner and less elastic, which a surgeon needs to plan around rather than ignore. I would recommend an in-person examination with a surgeon experienced in revision rhinoplasty, including a look inside the nose, before deciding how much surgery is genuinely worth doing for the improvement you want.
