How to correct uneven nostrils and off-center columella? Revision rhinoplasty (Photo)

Nostril symmetry is one of the more challenging aspects of rhinoplasty. It is even more complex after an aggressive base reduction.Bringing a deviated columella to midline may improve a bulk of the difference between two different sized nostrils. This is only true if the columella is moved to the side of the bigger nostril. To improve an over-reduced nostril, it may be necessary to use composite grafts (cartilage and skin). They will increase a small nostril, but they are typically visible on close inspection. I recommend consulting with someone who specializes in revision rhinoplasty. They can discuss what techniques may improve your situation as well as the risks involved. You'll need to understand all of this before moving forward with revision surgery. Safety comes first!

I'm sorry to hear about your experience elsewhere.  Based on the limited photos, it appears that your concerns stem from issues both inside and outside the nose.  The nostrils need to be revised to achieve a more symmetric result and because your septum also appears to be contributing to the asymmetry, a thorough exam of the inside of your nose is warranted.  The best recommendation is to consult with a board certified specialist in facial plastic surgery with a background in head and neck surgery who can assist you in achieving the results you seek. 3-dimensional computer imaging can help you visualize what you may look like afterwards and serve as an important communication tool with your surgeon. 

You must read my article in the Aesthetic Surgery Journal  "Nostrilplasty: Raising. Lowering,Widening and symmetry correction of the alar rim "  May June 2002   I was awarded aaward for this article and have done it over 100 times

From the pictures shown, the correction of the base and the tip does not require a rib graft.  This opinion might change on an in-office exam, but the pictures are fairly clear.  The right alar root needs to come down, the septum and the columella needs to be moved to the right, the alar footplate needs to be reduced on the right, and the tip needs to be thinned (more on the right).  This would improve your nose significantly.  Best wishes.

Straightening your septum and correcting the deviated columella will significantly reduce the nostril asymmetry. Although I have not examined you I question the need for rib cartilage to accomplish this. Remember that perfect symmetry rarely exists and would not be a reasonable surgical goal.