Will a septoplasty alone correct my crooked columella or should I consider a septorhinoplasty? (photos)

A crooked columella can be caused by a crooked lower septum. If this is the case it can be corrected by excising cartilage from the lower end of the septum. Yours is not nearly as bad as many I have seen so I would not let somebody do a complicated procedure on you.

A septoplasty will only correct the septum. However, your medial crura needs to be corrected but would require minimal correction.

Best Wishes,

Gary Horndeski, M.D.

The shape and size of the nostrils are controlled by many, many factors, and in today's rhinoplasty, we just aren't able to make predictable corrections to nostril symmetry. In fact, torquing or forcing the surrounding cartilage to try to make a symmetric nostril would risk a high probability of torquing and harming the appearance of the tip of the nose, which is seen in *all* the views, and which harm would be a huge downside to a possible attempt to working on the nostrils.

Now having said that, nostril asymmetry sometimes improves after work on the tip, if changes are being made, like elevating the tip, narrowing the tip; getting to work on the tip cartilages can help the nostrils. Sometimes.

My best advice, based on the small info I have: if it's truly *only* the nostrils that you care about, don't have any surgery. If there are *other* areas of the nose you care to improve, concentrate on them, and if you get some more symmetric nostrils out of the package, bonus. But if the nostrils are truly the high priority, leave them alone.

If you *do* want other changes to the nose: how *much* to elevate a tip, for example, or narrow a tip, or make other changes? We figure that out with morphs, well before surgery. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that any nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

In addition to a septoplasty you'll probably need either a columellar strut or septal extension graft.

Please provide pictures of your face to show whole face. it is impossible to make any recommendations based on the limited views.

Thank you for your question. After examining your photographs it appears you would benefit from minor work on your columella, lower nasal cartilages and nasal septum. It is important to know if you have any breathing difficulties, as this would determine how much surgery is required.
Based on your photographs alone, I would perform a limited septoplasty and release of the tiny nasal muscles next to your columella. The assymetry of the left nostril could be improved by minor adjustments to the cartilage of that nostril.
Please visit me in Boca Raton for a free in person consultation.

Dr. Rondi Walker
Sanctuary Medical Center
Boca Raton, Florida
561-367-9101
drwalker@spsboca.com