Uneven Nostrils - Can This Be Fixed?

I had rhinoplasty done back in 2000. I had a bump on my nose that was fixed. The surgeon did a minor refinement on my tip. He also lifted the angle of nose a little bit. I dont like the fact that i have one nostril bigger than the other. The surgeon didnt touch my nostrils. Is it possible to make the bigger nostril match the smaller one? Is this fixable?

Doctor Answers 16

Nostril and tip Refinement in Secondary Revisional Rhinoplasty

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Unfortunately you are in good company. Most rhinoplasty patients out there are very unhappy with their results in 1-2 years. The explanation for this is very simple: Most surgeons performing rhinoplasty do not have advanced training or experience, they perform the rhinoplasty of 50 years ago. Decades ago thought process of rhinoplasty was to remove cartilage to refine the shape of the nose and perform it through an open approach. An open approach makes it easy for neophyte surgeons to access visualize and manipulate the structures but also unnecessarily destroys two arteries and veins that are important for nasal vascularity. The open approach thus ensures that patients have 1-2 years of risidual swelling which hides the final result. Most rhinoplasties out there I consider cartilage robbing thus when the swlling resolves there is inadequate structure to provide aesthetic appearance and fight the cicatriacial forces or the continued scarring that results from the lowered oxygen tension and fibrosis of tissues. One additional problem it that most rhinoplasty surgeons out there inadvertently break the connection between the bony nose and the cartilagenous nose. this can cause irregular narrowing and what we calll "the inverted V deformity" which means the outline of the nasal bone becomes visible through the skin particularly in flash photography under certain lighting conditions.

In my opinion, an expert level rhinoplasty is always performed in a closed technique and ALWAYS involves grafting to add to the structural integrity of the nose. The act of opening the nose even under the closed technique causes healing and some contraction, thus for a long term beautiful result the nose must be left more structurally sound than it was found. This is missed upon most rhinoplasty surgeons.

In secondary cases such as yours it is even more crucial that sound grafting techniques are used. It sounds like at a minimum you will needa columellar strut but a complete L-strut and alar strut. I Definitely do not consider any rhinoplasty procedure that does not include grafting preferably by an experienced Plastic and reconstructive training with ddition fellowship level craniofacial and aesthetic training. Of course this is my bias because it is my training but I think this level of training is very necessary for success in secondary and tertiary rhinoplasty because there is delicate nuance involved and every patient requires different maneuvers. I hope this helps!

All the best,

Rian A. Maercks M.D.

Uneven Nostrils

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Uneven nostrils can be due to a deviated caudal septum, asymmetric lower lateral cartilages and differences in the size and shape of the alar lobules (especially after Weir excisions).  Additional views of your nose would be helpful to determine the best combination of procedures to improve you nostril symmetry.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 50 reviews

Fixing uneven nostrils

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Asymmetries on the tip and nostrils are very difficult to fix. With some limitations, cartilaginous grafting techniques can be performed to augment the weaker side. An alar rim graft may help with the right nostril. Sometimes a septoplasty can straighten the columella to allow better breathing. Spreader grafts can also help if there is a concave upper lateral cartilage creating a retraction of the tip on one side.  
 For many examples, please see our rhinoplasty photo  Gallery link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Rhinoplasty revision for uneven nostrils

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IF you are otherwise happy with your nasal appearance, I would urge you to be cautious in undergoing any additional surgical procedures as there is a risk for causing other secondary problems with the apperance of the tip. Currently, I don't believe the vast majority of your public would even notice the findings you describe.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Uneven nostrils can be repaired.

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I read your concern, and I saw the base view of your nose that demonstrates your nostril asymmetry. Very few people will view you from this angle, so if you're otherwise happy with your appearance, I would not recommend revision rhinoplasty surgery.

In general, the smaller side is repaired to restore symmetry, and maintain your airway. I think making your left nostril small like your right could impair your breathing.

All the best from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Uneven Nostrils

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Perfectly symmetrical nostrils are rare, but yours can be improved. You state that you would like to reduce the larger nostril, but that may compromise nasal breathing. Consult with your surgeon or see a revision rhinoplasty specialist to discuss alternatives.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Correction of nostril asymmetry

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Additional surgery is definitely an option is your are concerned about your nostrils.  It would likely require more support on the right, collapsed side using your own cartilage.  However I find that correction of nostril asymmetry is one of the most difficult things to promise in rhinoplasty.  Experienced rhinoplasty surgeons definitely get improvement, but rarely perfect symmetry.  So please keep this in mind if you consider more surgery. 

Kevin Robertson, MD
Madison Facial Plastic Surgeon
4.7 out of 5 stars 15 reviews

Uneven Nostril Correction

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Nostril asymmetry after a rhinoplasty can most likely be corrected by a secondary procedure.  To be sure, it would be useful to see your before photos. Discuss your concerns with your doctor and let him give you his recommendation based on your pre-operative condition and the procedure actually done.

Randy J. Buckspan, MD
Austin Plastic Surgeon
4.6 out of 5 stars 10 reviews

Nostril Shape Following Rhinoplasty

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Sorry to hear about your situation with the nostrils. Looking at your photo, it appears that your right nostril is smaller than it should be, which is likely related to something done during your rhinoplasty procedure. In many cases, this deformity can be seen when too much cartilage is removed from this region of the nose. The cartilage that normally supports the nostril rim is no longer present, leading to collapse much like you have in the photo. The corrective procedure would be to open the nose during a revision rhinoplasty procedure and reconstruct the nostril rim using cartilage grafting technique. This should help restore a more sound anatomical support for the nostril with the end result being more nostril symmetry. Make sure you consult with a revision rhinoplasty specialist in your area. Good luck.

John M. Hilinski, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 44 reviews

Nostril revision

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Hi, It looks like you may have had too much lower lateral cartilage removed on the right side. You would require an open rhinoplasty with correction of the right upper lateral cartlage and a cartilage strut graft. The cartilage grafts can be harvested from the septum and/or the ear.   Best, Dr.S.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 reviews

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.