Appreciated Expert Advice

Hello--I posted pt 1 of this question last night and received some great and much appreciated expert advice but was told the nostril asymmetry wasn't showing so I posted new pics. Last week, I sent the same pics I posted last night to my Dr. and was advised via his reception that it was just swelling and that these issues would all be resolved as the swelling subsided. So...I'm just grateful for the advice and concern. The nostrils may show better. Again, I appreciate any advice.

Doctor Answers 6

1 Month Post Rhinoplasty

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  From the photos, IMHO, the asymmetry of the nostrils are a direct reflection of a deflected anterior septm to the left combined with tip cartilage asymmetries (the left tip is lower than the right making the left nostril more horizontally oriented).  The indentations along the dorsum seem significant but there's no way to tell if this is swelling or over resection of the dorsal cartilages.

  Having said all of that, IMO, you should have this discussion and follow the post op advice of your Rhinoplasty Surgeon.  Frequently, correcting asymmetric nostrils is not part of the Rhinoplasty plan and only you and your Rhinoplasty Surgeon know what was discussed pre-operatively.  Correction of asymmetric nasal tip cartilages, IMHO, would require specific tip plasty techniques designed to even them out.  As the tip cartilages become more symmetric, so go the shape of the nostrils.  Hope this helps.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Rhinoplasty and nasal asymmetry

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Hello Savannah1798,

I respectfully disagree with the other responders about it being too early to tell.  I agree that it has been a short period since your surgery, however the photographs you posted clearly show a (probably persistent) deviation of the caudal and dorsal septum that manifests as nostril asymmetry, a 'slanted' columella, and deviation of the bridge and tip of your nose.  In addition, you have an irregularity on the bridge of your nose that corresponds to either septal or upper lateral cartilage excess.  I believe that these issues will not go away with time, unfortunately.

I think that you will benefit from a revision rhinoplasty in the future.  The traditional dogma states revision surgery should not be attempted before one year, however performing it earlier should be considered on a case by case basis.

Revision rhinoplasty is more difficult than primary rhinoplasty, and you should consult with surgeons that have a reputation as rhinoplasty specialists.  These people should be certified by either the American Board of Plastic Surgery or the American Board of Facial Plastic Surgery.

Best of luck.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Here are some facts....

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One month is very early but unfortunately as swelling goes down, people with thin skin such as yours end up noticing more irregularities and not less.  I have not seen your "before" pictures.  Perhaps you can focus on the improvements so far and then plan a revision a year from now.  The nostrils are almost never perfectly symmetric in most people but the issue that is making things worse is the notable asymmetry of your tip cartilages (the lower lateral cartilages) which you can see on the base view.  These may have been there before surgery and not addressed nor improved or these asymmetries may have been created by the rhinoplasty.  Hang in there.  Dont panic.

Shervin Naderi, MD, FACS
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 119 reviews

Rhinoplasty and post-operative complications

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One month is too early to see what is going to happen.  Also, without actually examining the nose, one can't tell if the asymmetry is from uneven cartilages or uneven swelling or unusual scarring.  However, it is possible to influence healing with appropriate post-operative care.  Occasionally, cortisone shots can help reduce aberrant scarring.  Also, compressing the raised areas daily in a controlled manner can reduce the swelling an improve the final outcome.  This are issue to discuss with your surgeon. 

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 18 reviews

Your nostril asymmetry and nasal dent.

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Hello, thank you for the photos.  Generally, I am in agreement with Dr. Joseph.  The nasal asymmetry you have, particularly from the front view, may very well improve over the coming weeks to months.  This retraction that you have can be helped with an injection of steroids and other anti-fibrosis medications into the area above your ala (nasal lobule) on your right.  You would couple that with stretching or pulling excercises on that right side.  Sounds simple, but it can make a difference.  Let me strongly caution you from doing anything surgically to correct that particular issue any sooner than 6 months post op.  This can provoke some anxiety but be patient.  As for the "dent" on your nasal dorsum I agree it can be improved with a filler or Silikon, however, I prefer to use your own tissue to correct that at a later date.  The tissue, known as fascia, can be taken from behind your ear and all this can be done under local and access to nasal bridge would be via an internal nasal incision.  Hope that helps, but do be patient and see how things look in a few months.

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

Follow-up answer regarding nostril asymmetry and nasal dent after Rhinoplasty Surgery.

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Greetings. Your newly posted photos are helpful. Here's my take:

It is definitely too soon to judge your final result, only one month after Rhinoplasty Surgery. I see your two concerns. You have very thin nasal skin, so you may see minor irregularities more than someone with thicker skin.

The indentation in your bridge is small. It may not get better, but this may be improved, quickly, with an injectable Filler treatment. Again, my personal preference is to use Silikon-1000, a permanent off-label filler. I use Silikon-1000 liberally in my own nose job patients. in patients with thin skin like you, a small amount of silicone can lead to a world of improvement in my experience.

Your nostril asymmetry is a bit more involved. Your columella is tilted toward your right (possible deviated septum), and you appear to have nostril retraction on your right. The base of your nose and tip will certainly change, and possibly improve, over the next few months.

You had a closed rhinoplasty and have a relatively small amount of swelling only a month post-op. You will get an idea where you stand, long-term, over the next 2-3 months.

In my practice, nasal indentations and nostril asymmetry may be improved non-surgically with Silikon-1000, and my practice philosophy is to reserve a revision rhinoplasty as a last resort. If you're concerned by your appearance certainly get a second-opinion from a revision rhinoplasty specialist, or a facial plastic surgeon experienced in the delicate art of using fillers in the nose.

I hope this helps you, and all the best to you.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.