Nostril and tip asymmetry - can this be fixed without an open rhinoplasty? (Photos)

This is a very challenging situation. You will need a cartilage graft on the narrow side to get some symmetry. Even then you need to have realistic expectations.
Also, realize that once you become self conscious of your nose then it feels like everyone is looking at it. In reality very few people can notice unless you bring it to their attention.
Regards
Dr. Janjua

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. The nostril asymmetry can be corrected. This should be done with open rhinoplasty. 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.
Harvard-trained plastic surgeon

As a surgeon who has long used both techniques, I can say that your nose can indeed be revised using a closed approach. I don’t believe there is a significant difference in outcome between open and closed techniques in your case.However, it’s important to note that most, but not all, of the asymmetries between your nostrils can be corrected. Typically, about 80–90% of the current asymmetries can be improved, while 10–15% may remain. The result would be a natural-looking nose that is harmonious with your face, more aesthetically pleasing than your current appearance, and functions better.

Open vs. closed rhinoplasty often depends on the surgeon’s preference. In my opinion, open rhinoplasty provides better access to the nasal structures and can yield more precise results.In your case, the asymmetry is likely due to underlying structural issues. These must be addressed to correct the nostril asymmetry and notching at the soft triangle. Most likely, you would need at least a septal-extension graft to support the tip, along with alar rim grafts to support the ala for improved symmetry and reduction of notching.

Based on what we see, you appear to have had previous rhinoplasty surgery, and you also appear to have left nostril margin retraction. Microdroplet Silikon-1000 injections may be considered for improving upon your nostril margin symmetry, without the cost, uncertainty, and inconvenience associated with another nasal surgery. I hope this helps! Sincerely, Dr Joseph

Your photos show a true dorsal axis deviation, not a small surface irregularity. When the bridge is off line it often reflects septal deviation and a twisted middle vault, which usually need structural correction.
Before choosing an approach it helps to understand why you prefer to avoid open surgery. Some tools that improve precision such as piezo ultrasonic osteotomy are typically used with open exposure where visualization is safest.
What may help• Closed revision if the problem is a limited bony shift without midvault twist• Open septorhinoplasty when cartilage and bone are both deviated or when precise grafts are needed• Grafts from septum when available, ear if needed, rib only when greater support is required
What has limited value• Filler can camouflage a mild curve on frontal view but does not correct deviation or improve airflow
Key questions for the consultation• Is the septum straight and is the internal valve stable• Will osteotomies and spreader grafts be required• Would using piezo add safety or precision in your case• What scar care is planned for the small columellar incision if open is chosen
The information here is not enough for a precise plan. A deeper analysis with standardized photos and history will define whether a limited closed approach can work or whether a structured open approach is safer. Coordinators can help collect these details through a complimentary conversation if that would be useful.
Wishing you clarity and a plan that restores both balance and comfortable breathing.Güray Yeşiladalı, MD