Filler Injections for Uneven Nostrils? (photo)

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.

In recent years application of fillers to address irregularities following an unsuccessful rhinoplasty has become more papular despite some potential for very rare but catastrophic complications such as blindness or loss of nasal tissue.  The most common areas amendable to such touch ups are nasal sidewall, bridge or the tip.  Asymmetries of the nostrils are best treated surgically and often with application of cartilage grafts.Based on the photographs shown above the asymmetry of your nostrils seem to be minimal, and if I am not mistaking on missing a major asymmetry not easily noticeable on this picture then I would reconsider the desire for further treatment, as it is almost impossible to achieve perfect symmetry from rhinoplasty.

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. 

Fillers can be an option to correct asymmetry non-surgically.  You would want to set up a consultation because without seeing you in person it is difficult to tell.

I think that hyaluronic acid fillers are very useful in revision rhinoplasty as a temporary correction or to correct a low dorsum as seen in Asian patients.  Hyaluronic acid filler can be used to correct slight asymmetries or after primary rhinoplasties that need to wait for at least a year before considering other surgery.   Use of fillers allows for normal wound healing and restoration of a reasonable appearance until definitive nasal surgery can be done, 1 – 1.5 years after previous nasal surgery.

Filler injections in the lower third of the nose, especially after scarring has taken place can be tricky. I would avoid anything permanent. In fact, your surgeon may be able to inject saline or local anesthesia in the area to "simulate" what a filler may accomplish. In the end, minor revision surgery may be the best option.

I am glad to see that most of the surgeons who have answered this advised against the use of fillers for nostril asymmetries after rhinoplasties. The likely hood of a good cosmetic outcome with these materials in the nostril is low, while the chance of a severe skin complication is high. 

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

I read your concern and reviewed the photo of your nose. It seems like you're unhappy with the height of your nostrils. Your right nostril appears a bit higher than your left.

In my practice, I have had wonderful success lowering nostril margins using Silikon-1000 as an off-label, permanent Injectable Filler.

I've attached a link to a photo in my RealSelf gallery demonstrating nostril lowering using Silikon-1000.

I hope this is helpful for you.

Correction of asymmetry of the nostrils is performed mainly through meticulous surgical revision.  Fillers may not provide long term or adequate response and thus should be avoided at this point. 

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