Nostrils Uneven After Nose Lengthening Surgery, Options To Fix This?

Obtaining complete nostril symmetry after revising alar retraction is extremely difficult.  Grafting procedures such as alar rim grafts or lateral crural strut grafts are required to lower retracted ala.  Excisional procedures do not typically change the height of the ala on the lateral view. Rather, they narrow the nasal base on the frontal and base views or decrease the nostril size.

Three months post surgery is still very early for you to judge the results of your surgery, and typically it is a good idea to wait about one year before seeking a revision.  There are a few minimally invasive options for improving nostril symmetry and a lower nostril can be elevated is desired and aesthetically appropriate.

This is a terrific question and one that poses significant quandries for you and the surgeon.  The short answer to this question is that before you consider any revision or further surgery you will want to wait a full 12 months prior to engaging in another consult.  Stick with the primary surgeon and ride out this period of healing.  Dramatic changes will occur in the nostril ala (rim) during this time frame and you might find that the 3mm turns into 1mm after all the swelling and healing subside.  The skin of the ala is the thinnest and most amorphous as the majority of this region is fibrofatty ligamentous tissue and not true cartilage.  When grafting this area, a large ammount of swelling is common and difficult to combat.  Time. Time. Time will prove all. 

But if at the 12 month mark you are still bothered by the appearance then reengage in this concept.  Traditionally, most rhinoplasty surgeons would shy away from overresecting the other ala because this would just cause to alar retractions that might look okay for the first few years but will eventually result in an overrotated nose that allows observers to see directly into your nostrils defeating the purpose of the rhinoplasty in the first place. 

So give it time and really think about considering further grafting ... but only if necessary.  You may find that symmetry, or close symmetry exists at one year and no further surgery is necessary.  But if it is...have a very specific conversation with either your primary surgeon or one that is VERY comfortable with revision surgery.

You cannot judge nostril symmetry 3months after your rhinoplasty. If you're not satisfied after another 6 months a minor revision will improve your appearance.

Alar rim height may not be stable for as long as a year after surgery, especially when grafts have been used.  I suggest daily massage to raise the low side and lower the right side.  Do this regularly and expect the most results by gently tugging the high side down by grabbing your nostril edge with thumb and index finger.  If asymmetry persists when you are twelve months out from your procedure surgical revision may be considered.  Revision rhinoplasty, especially after grafting, is a complex endeavor.  I would lower the high side or raise the low side, or a bit of both, depending on quality of scar tissue and location of previous grafts.