Can you shave down the medial crura after rhinoplasty? (Photos)

After looking at the photos, I think more than just a little shave will be needed to give a good long term result. The septum needs to be fully dissected, freed from it's location on the left and physically swung back to the midline. Then it is sutured into position and will have a much better chance of remaining in position. Be sure to see a rhinoplasty expert for consultation.

In general, when there is a bulge of the medial crus, this is not due to cartilage asymmetry of the tip. Rather it is due, in most cases, to a deviated nasal septum. Consider getting a second opinion from another reputable rhinoplasty specialist before having anything performed under local anesthetic to your medial crus.

Hello and thank you for your question. Based on your photographs, this asymmetry can be corrected by excising and suturing some of the medial crural footplate and possibly excising some deviated caudal septum. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

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

Thank you for your question,
Breathing may seem simple, but it’s a complex journey that begins with your nose and ends in your lungs. Along the way, every structure in the airway plays an important role, and any disruption in the system can affect how easily you breathe. The air enters first through your nostrils, which must be a healthy and open size. If the columella—the strip of tissue between your nostrils—is too thick or hangs low, it can already create resistance to airflow at the entrance.
From there, the air moves past your septum and through the nasal valve angle, which is the space between the septum and upper lateral cartilages. This angle needs to be greater than 15 degrees for smooth airflow, but a deviated septum or even minor swelling can reduce it significantly. Something as small as nasal hair or inflammation can narrow this passage. If the septum is not in the midline, it pushes the airflow to one side, and the structure on the working side—especially the turbinates—can become swollen over time. Turbinates naturally grow and shrink in cycles, but when one side works overtime, it becomes chronically inflamed, making breathing feel even more difficult.
Further down, the ducts under the turbinates help the sinuses drain. A deviated septum can block these ducts, leading to sinus infections and pressure. And beyond the nose, the air must pass the epiglottis and continue down through the trachea into the lungs. The entire path has to function together to make breathing effortless.
So when it comes to improving function, it’s almost never about one part alone. A thick columella, a deviated septum, narrow valve angles, inflamed turbinates, and blocked sinuses can all work together to cause problems. In many cases, correcting the septum helps balance the airflow, reduce inflammation, and restore harmony. Shaving the medial crura alone may not address the full picture.
That’s why breathing isn’t just about one feature—it’s a system. And when all the parts work together, the result is not just better airflow, but a nose that truly functions as beautifully as it looks.