Why is One of my Nostrils Bigger Than the Other, but Yet I Don't Have Breathing Problems? (photo)

Question

Just wondering if I have what many say is a deviated septum. Just wondering what it would cost for a more symmetrical look.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you have a deviated septum and may benefit from septoplasty and a septal reset. This can be safely combined with rhinoplasty during the same surgical procedure. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Naveen Cavale, MBBS, MSc, FRCSEd(Plast) · Answer

A little difference between the nostrils is very common, and very normal.
Differences can also be caused by trauma, which has resulted in deviation of the bone and outer cartilage, or perhaps because of septal deviation. Again, a little septal deviation can also be normal.
If you are not sure, it is definitely worth seeing a board certified (GMC registered) plastic surgeon who can have a look and advise you what your options are.

Matthew Richardson, MD · Answer

The main reasons to have surgery on the nose would be for either cosmetic purposes (appearance) or for functional purposes (nasal breathing). If a patient is breathing fine through the nose, there is no reason to perform surgery on a deviated septum.
Based on the photos provided, the overall shape of the nose is fine, but there appears to be some obstruction of the left nostril due to either deviation of the septum, or some irregularity of the cartilages at the tip of the nose. These issues can be corrected (or at least drastically improved) with surgery, but surgery would only be recommended if cosmetic changes are desired or there are nasal breathing problems.
Be sure to see a rhinoplasty expert.
All the best,

Shahriar Mabourakh, MD, FACS · Answer

It is probably one of the more common questions my patients ask. It is normal for nostrils to be different in size or shape. Nostrils typically do not effect breathing unless they are very small or collapse while breathing. No surgery is necessary if there is no problem with breathing through the nose.

Evan Ransom, MD, FACS · Answer

Thank you for the photo and the question. As others have said, most people have some degree of asymmetry of the nostrils. In your case, it looks like either your septum is deviated to the left, making the left nostril smaller; or, your tip cartilage on the left (medial crural footplate) is flared out into the nostril space. Each of these problems can be addressed with rhinoplasty. However, if you like the way your nose looks and you don't have breathing issues, then nothing needs to be done.

Christopher Cote, MD · Answer

Your picture appears to show a deviated septum narrowing your left nostril.  Sometimes this is an unacceptable appearance to people and sometimes it causes nasal obstruction.  Patient's can report a variety of symptoms.  A consultation may be worthwhile to fully examine the nose.  There likely are  treatments that would improve your condition.

Umang Mehta, MD · Answer

From your photos, it's evident that the very front of your septum, what we call the caudal septum, is deflected into your left airway. This can obstruct the external valve of the nose and cause difficulty breathing for some patients. In these cases, correction of this deviation (septoplasty) may be considered medically necessary and insurance coverage could be obtained. 

	If you are breathing normally, correction of this issue would likely be considered cosmetic. Straightening this cartilage would involve shaving the septum a bit and using sutures to straighten the deflected portion. If this were the only issue to be addressed, the surgery would be quite short (30 minutes) and could be done quite comfortably under a combination of light sedation and local anesthesia. Or, should you so desire, general anesthesia could be used. Your procedure could be done through a closed (endonasal) approach. Hard to give you a precise figure without an examination but a ballpark cost for a straightforward case such as this would likely be in the $3K range.

	Best regards,

	Dr. Mehta

Adam Bryce Weinfeld, MD · Answer

Clearly both of your nostrils are large enough for air to flow through them

	the same must be true for the passage ways behind them

	 

	I see what you see 

	the aperture of your left (to the right in the picture but your true left) nasal vestibule does appear smaller this makes the nostril look smaller 

	the cause of this is likely caudal septal deviation

	 

	Why do you ask?

Barry M. Weintraub, MD, FACS · Answer

It appears that you have a deviated septum, but if you do not have any breathing problems and you like the way your nose looks, as a specialist in rhinoplasty surgery, I would recommend not doing surgery. No two nostrils are exactly alike so it is normal to have slight differences from one side to the other. If the difference bothers you, surgery would be recommended. Please keep in mind that from normal angles, the nostril asymmetry does not show. The cost of the procedure would vary based on location, the surgeon's experience and the facility it's performed in.

Jacqueline Wegge, MD · Answer

Excellent question.  From looking at your pictures it appears as though you likely have a deviated septum with the cartilage bent into the left side of your nose.  This gives the appearance that your nostrils are asymmetric, when in fact the left side looks smaller because it is being partially filled with the cartilage that is deviated to that side.  If overall you are happy with the shape and appearance of the nose, and you do not have any breathing problems, there is really no need for surgery.  If you have more questions, you can always schedule a consultation with a surgeon that can examine your nose and address any concerns.