One nostril higher than the other, 4 months after rhinoplasty, is this permanent? (photo)

It's too soon to tell what your final results will be. You need to have patience with your body as it begins to heal. The skin, bone and cartilage are all traumatized during surgery. Inflammation (swelling) is the normal response and will help your nose to heal and look beautiful in the end. If, one year from now, you are unhappy with your nose, then that is the time to think about a revision procedure. Right now, concentrate on other things you like to do and let your nose and under eyes take the time to heal. I hope this helps.

It's too soon to tell what your final result will be. You have to give yourself some more healing time.  Your nose and surrounding areas are going to be swollen for a while and you should be consulting the surgeon that performed the procedure but give yourself some time before going back in so some of it can subside. It can take up to a year for final results.
Sincerely,
Philip J. Miller, MD, FACS Double Board Certified Facial Plastic Surgeon

You still have some time in regards to your healing so be a bit patient. If there continues to be some asymmetry at about the six month mark, then I would start thinking about a revision surgery to lower the higher rim. Best of luck