Filler Injections for Uneven Nostrils? (photo)

I recently had a revision rhinoplasty and I heard they can use permanent injections for ''touch ups.'' I was wondering, when can I go and ask for a little injection above the lifted nostril to make it seem less big?

Doctor Answers 23

Filler injections for uneven nostrils?

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I have to admit that your nostrils, while not perfectly even, do not seem that uneven enough to warrant any type of intervention.  IMHO, you shoukd just leave your nostrils alone.

Caution in Using Fillers Around Nostrils

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Fillers can be helpful for adjusting flaws in the nose, but mostly in the upper 2/3 of the nose.

I have used fillers in the tip, but caution is essential. Your surgeon can test the correction with saline (salt water) or local anesthetic solution; these solutions will absorb quickly if the injection isn't producing the right effect, while fillers can last a long time.

If the photo indicates the asymmetry about which you are concerned, I'd advise you to abandon seeking perfection (no one is perfectly symmetric). Your efforts for perfection will be frustrated and may lead to worse results.

Fillers don't last and you will be disappointed in the long run

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Fillers are temporary. For uneven nostrils there are ways to do this with grafting from the septum or the ear. Excision of parts of the nostril can also help.

1. For the snarl look this can require ear grafts inside the nose to bring the edge of the nostril down

2. If it is the uneven skin portion on the sides of the nose you can make excisions around the edges and within to manipulate the way it looks

3. when it involves the portion of your nose that is in the middle or the columnella you can do procedures here to make that part go higher to make the nostrils look less open from the side view

Based on your picture, I think that the right nostril looks a little higher. This can be treated with a composite ear cartilage graft of skin and cartilage taken from the part of your ear that is above your canal and is the anterior portion or the anterior helix superior to the helix crus. This graft can be placed inside your nose right where it is higher to bring that part of the skin down.

Philip Young, MD
Bellevue Facial Plastic Surgeon

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Nostril Asymmetry: Surgery vs. Fillers

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The best bet for correcting asymmetric nostrils is revision surgery. First of all, placing fillers along the nostril edges is unreliable in revision cases as you are fighting against scar tissue in attempts to lower the nostrils. The result may be to thicken your nostril rim and create asymmetry in a different direction. Secondly, permanent fillers in the nose should be avoided, in my opinion, due to the risk of lumps or irregularities. Placement of a small cartilage graft along the rim can be done quite easily and comfortably under local anesthesia (+mild sedation if needed) and the results are much more predictable. Best of luck!

Dr. Mehta

Asymmetric Nostrils and Revision Rhinoplasty

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Hi AJ, You should be very careful and avoid filler placement in your nose.

Even though it may be tempting to do so, it can cause irreversible negative changes to your skin that would be very difficult to correct. It is not FDA- approved. Avoid it.

The best option is to wait for one year and allow the swelling to resolve. Consult your surgeon to go over all your options.

Good Luck,

Dr. Sajjadian

Fillers won't help, you need cartilage graft

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I use short-term fillers on occasion for the bridge with some success but not for the nostril margin (alar margin). To improve the asymmetry a cartilage graft is what you need. This could be a minor procedure performed with minimal internal incisions and no/minimal anesthesia.

Non-surgical rhinoplasty and asymmetric nostrils

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I have been disappointed with fillers to correct nostril asymmetries. My disappointment is even greater when it comes to noses that have already been operated upon with rhinoplasty. There are several reasons for my disappointment:

1. Temporary fillers are compressible and do not distend the tissues in the tip of the nose. What this means is when a soft filler like hyaluronic acid or injectible hydroxylapetite is injected, it does not easily stay where it is placed, leading to less-than-optimal outcome.

2. Permanent fillers are less compressible but if placed incorrectly will leave a permanent lump that may be worse than the original problem.

3. Fillers hurt. Even with topical preparations to numb the skin, the injections are quite painful in the tip of the nose. The tip skin can not be injected to anesthetize it before a filler injection because then there will not be enough potential space for the filler to occupy.

4. Even in my most tolerant patients, most who have tried fillers eventually go on to have surgery. In experienced hands, the surgery can give a much better permanent result than any filler.

5. I have used fillers for correcting small imperfections along the bridge of the nose, but now no longer recommend them for tip irregularities to anyone.

Hope that helps!

Minas Constantinides, MD
Austin Facial Plastic Surgeon

Asymmetric nostrils

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Asymmetric nostrils will not be improved by filler material. To correct this problem it really depends upon the asymmetry.

1) flare- nostril excision

2) width of base- nostril excision

3) thickness of nostril itself- very difficult but some doctors debulk them from within a nostril rim incision.

Filler materials to make one look fuller may cause problems.

Uneven Nostrils

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I can appreciate the uneven nostril shape you have though it is very subtle.  The best option would be to talk to your rhinoplasty surgeon about correcting this or talking to another surgeon about revision surgery.  Injections are used to raise a hump, create the illusion of narrowing of a tip, or creating tip raise, or helping with dorsal irregularity.  Also, injections are temporary and have to be repeated annually. 

revision rhinoplasty for uneven nostrils

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 The amount of unevenness is within normal limits and probably should be left alone.  Fillers are not  used in the tip of the nose, so a cartilaginous graft will be required to be harvested from inside the nose and placed along the alar margin and rim.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.