Can I make my nose smaller and more symmetrical? (Photo)

Question

5'2 I have had 2 rhinoplasty procedures done in the past and one permanent filler injection. My right nostril is bigger than my left. I have gone to several surgeons and have been told there is nothing more that can be done. I still feel my nose is large and would like the right side to be more symmetrical to the left side of my nose. Any reccomendations. I was told to do fillers but I would run the risk of increasing the size of my nose. I would like a smaller nose.

Randal Haworth, MD, FACS · Answer

"Nothing more can be done" is usually shorthand for "nothing safe with the tissue that is left." It rarely means the asymmetry is unfixable in principle. The larger nostril may come from the alar cartilage, the alar base, the columella, the septum or scar, and permanent filler muddies every one of those, because it distorts the tissue and is hard to remove cleanly. After two operations, the real planning question is how much cartilage and healthy skin remain for grafting. Fillers will not make the nose smaller. What is realistic for you can only be answered with your nose in front of someone who handles revision noses all the time.

Alexander Ovchinsky, MD · Answer

Thank you for your question. It’s difficult to make a meaningful assessment from this one photo because only the lower half of the nose is shown. I also see some nostril asymmetry, although the side that appears wider to me looks like the left rather than the right, so the orientation of the photo may be reversed.

Nostril symmetry is one of the trickiest aspects of rhinoplasty, and it can be particularly challenging to improve after two previous procedures. That does not necessarily mean that nothing can be done.

Since your goal is to make the nose smaller, I would not favor filler. Filler adds volume and could actually make the nose look larger.

Looking at your photo, a revision procedure may be possible using cartilage grafting to bring the more retracted/higher nostril margin down and improve its shape, potentially combined with selective alar base reduction to narrow the wider side (or even both sides). The exact approach would depend on the underlying cartilage and soft-tissue anatomy.

I would need to see additional standardized views, particularly a true frontal, profile, oblique, and base view, before determining whether this could realistically be improved and how much reduction would be possible.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you may benefit from a revision rhinoplasty. A surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. The nostril asymmetry can also be improved. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D. FACS
Harvard-trained board certified plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D. FACS
Harvard-trained board certified plastic surgeon

Can I make my nose smaller and more symmetrical? (Photo)

Answers (3)

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