Is my Left Nostril Retracted or It Looks Retracted Because my Tip is Twisted? What's the Best Way to Fix This?

I had open rhinoplasty last year. My nostril bothers me alot. I want to de-project and counter rotate the tip. I also would like to bring my nostril down without making my tip any narrower. Would like to bring the tip in the center. What kids of work would I need ?

Doctor Answers 8

Rhinoplasty for Twisted Tip or Crooked Nose

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Thank you for your question. From one limited photo it is difficult to evaluate your nose.

However a deviation of the nose to the left begins in the mid nose where the transition from bone to cartilage begins so your nose appears to be crooked and twisted from right to left.

A straightforward Rhinoplasty to re align your bones and nasal septum should be the first consideration.

The distortion of your nostrils is most likely caused by the twisting forces created by the crooked nose.

I would certainly attempt to improve the nostrils by re aligning the bones and septum before considering complex grafting procedures


Retracted nostril and twisted nasal tip

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The left nostril is more retracted than the right and can be addressed with a composite skin graft taken from the ear.  Further attempts to bring both nostrils down can be done through closed rhinoplasty techniques.  Counter-rotation of the tip can be accomplished by judicious trimming of the caudal septum.


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It's hard to tell from only one photo.  A side view would be helpful.. It looks like you may have a hanging collumella, which is a pretty  simple thing to correct.  You need some of the septal cartilage removed and nasal lining trimmed to correct this problem. It may also be helpful in correcting the assymetrical collumella.

Nostril Retraction and Tip Asymmetry

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You have a hanging, asymmetrical columella that can be lifted to correct the problem. You will need an alar graft to lower the nostril rim. Th tip also looks asymmetrical. I cannot comment on the other changes you're considering with the one view you submitted. If you want to submit a complete set of rhinoplasty pictures go to my website for instructions.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Rhioplasty to fix alar retraction , etc.

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With only one view I cannot give you a proper answer.  That said, you look like you prob ably have a hanging columella as well as alar retraction.  This can be fixed with excision of the columellar excess from the septum with or without an alar composite graft.  Choose a revision rhinoplasty surgeon who is very experienced for the best result. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Is my Left Nostril Retracted or It Looks Retracted Because my Tip is Twisted? What's the Best Way to Fix This?

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 The slight variation between the nostrils with the left slightly higher is most likely due to the higher attachment of the left nostril, to the face, combined with slight internal asymmetry of the tip cartilages...left being higher.  The easiest way, IMHO, to adjust this would be a rim composite ear graft to slightly lower the left alar rim.  This would not require a Rhinoplasty and could be done as a isolated procedure.  You should ask your Rhinoplasty Surgeon his/her advice on the issue.

Alar retraction treatment

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There are a few ways to treat retracted ala. A rim graft can help with modest changes. Lower lateral cartilage repositioning is another way to address the problem. This can be done at the same time as the other tip work you're interested in. It's hard to comment on that aspect without seeing other views of your nose.

How to fix the nostrils in revision rhinoplasty

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Thanks for the photo and question. In all likelihood, your left lower lateral cartilage was thinned (cephalic trim) in order to help refine your nose. If the remaining cartilage is insufficiently strong, this can lead to nostril retraction and collapse and perhaps difficulty breathing. This loss of support can also cause tip deviation to the left. 

Restoring strength to this cartilage would involve harvesting a stronger piece of cartilage from your septum and placing it underneath your existing cartilage (lateral crural strut graft). This graft can be placed in such a way that it pushes the nostril rim down and forward. In cases of more severe retraction, rim grafts or composite grafts are also options. 

As for deprojecting and counter-rotating your tip, one option would be to divide and overlap the medial crura (medial crural overlay), the portions of your tip cartilages which sit between your nostrils. This would rotate the tip down and bring it closer to your face. Of course an in-person exam would be needed to fully assess your situation.

The final bit of advice is that if you are having difficulty breathing, you should consider whether insurance coverage may be acquired, which can help offset a significant portion of the cost of your surgery. Be sure to consult with a revision rhinoplasty specialist, for whom your issues should be fairly straightforward. 

Best regards,

Dr. Mehta 

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.