Had revision rhinoplasty, tip is straight but columella and nostrils are uneven. Prone to scarring, should I fix it? (photos)

Question

Had revision rhinoplasty 3 years ago, I liked everything about the result except the columella which make it seem as if my nose is crooked, but from the front view, the tip is pretty much straight, but the nostrils are uneven. What is this and what can be done? Should I get this fixed, I'm prone to scarring and don't want to make things worse.

Robert Kotler, MD, FACS · Answer

Dear Mandie18;
Your nose shows evidence of having nostril narrowing and
an open rhinoplasty approach. It's true
that the columella and the shape of the nostrils are not ideal. The columella is asymmetrical, and it looks
like the front portion of the septum is protruding from behind the columella
into the right nostril. Also, the
natural configuration of the nostrils are different with the left showing a
very sharp peak. That peak is higher
than the more oval-shaped right nostril, but that nostril is perhaps also being
affected by the distracted nasal septum.
Frankly, to improve the septum and its relationship to
the tip and a possible contribution to the asymmetry, surgery would be
indicated. Your concern about scarring
is valid, but of course, that can all be done internally where scarring is not
an issue. You have not mentioned
anything about the scars on the nostrils' floor where the nostril narrowing was
done; if you are satisfied with that, that's fine.
With respect to the nostril asymmetry, that's going to
be an important subject for discussion with your surgeon because the question
is if you would be best served by having an additional procedure on
the nostrils in the hope of making them more even. Or if that could be
corrected by nonsurgical means. Look
carefully at the latter option because you deserve consideration for
any and all means short of surgery.
Best wishes,
Robert
Kotler, MD, FACS

David Reinstadler, MD · Answer

Making the nostrils perfectly symmetric is a very difficult task. I believe from your photos, the asymmetry can be improved greatly. It also looks like you had alar base excisions which can alter the rotation of the columella as well. An in-person examination would be the best for you to get a reasonable idea of what is possible. Best of luck

Richard W. Fleming, MD (retired) · Answer

The columellar irregularity is probably secondary to deviation at the end of your septum or asymmetry of the tip cartilages in that location. I need to examine your nose but if I'm correct these problems can usually be corrected with a minor revision that can be done under local anesthesia.

Had revision rhinoplasty, tip is straight but columella and nostrils are uneven. Prone to scarring, should I fix it? (photos)

Answers (3)

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Everything you need to know about Revision Rhinoplasty

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Had revision rhinoplasty, tip is straight but columella and nostrils are uneven. Prone to scarring, should I fix it? (photos)

Answers (3)

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.