Nostril reduction during rhinoplasty - how do surgeons ensure nostrils are the same size?

I often do alarplasty to reduce nostrils under local anesthesia with the patient awake. Then we can measure it out together and make sure the patient is pleased at the end. It avoids a lot of finger pointing later

Nostril symmetry after nostril tuck: nostril symmetry after nostril tuck is certainly a goal of any surgeon. Some may use instruments such as calipers to measure the amount of tissue to be removed on each side. Most surgeons also use a surgical pen to mark the size of the excision. Final symmetry also depends on whether or not the nostrils were symmetrical to begin with. in the end given the fact that the nose is swollen during the surgery and given the various changes that occur during healing and scar formation, and given the minute asymmetry is that most people have before surgery, and given the other procedures that are performed on the nasal tip, it is not unusual to see minor asymmetries after the healing process is complete. These are usually minor and easily correctable in the office under local anesthesia in most cases.
it is not uncommon to have minor asymmetries when the healing process is complete.

During surgery, and especially when trying to obtain symmetry, most surgeons will do measurements of the nostrils prior to excision and also measure the tissue to be excised. It is important to understand that nostril size not only relies on the nostrils themselves but are also influenced by the surrounding facial asymmetry which every person has. As such, no person has perfect symmetry before or after surgery.If your nostrils are equally sized prior to surgery, the measurements would be made to ensure that the same amount of tissue is removed from either side.

Hi and welcome to our forum!
Each plastic surgeon has developed an individual operative protocol based upon training and lifelong surgical experience. Some surgeons employ a small ruler, some use a caliper, some will design the excisional pattern on a segment of metal foil (usually from a suture package) to copy on the opposite nostril with a marking pen to optimize symmetry. I am sure there are other ways as well!
Best wishes...