Can reducing the columella help with nostril asymmetry?

Hello! Thank you for your question.
Reducing the columella alone usually does not correct nostril asymmetry, since the asymmetry often comes from the cartilage or soft tissue structure, not just the columella. Rhinoplasty without grafting can be done in some cases, but grafts are often needed to achieve stable,
It would be better face to face consultation.
Best Regards!

We have seen notching of the nostril margin after placement of a nasogastric tube that was taped to aggressively to the nostril margin. It also had good success in lowering the retracted nostril with microdroplet Silikon-1000 injections, and this has been a welcome alternative to the inconvenience, cost, and uncertainty associated with rhinoplasty surgery. They say that a photo is worth a thousand words, and in that regard, please feel free to re-ask your question with pictures of your nose. Wishing you well moving forward. Sincerely, Dr Joseph

The nostril can be improved with a small cartilage graft. The graft can be obtained from the dorsal hump that will be removed. You will not need a rib or ear graft.
Columellar reduction can also be done at the same time.
Regards
Dr. Janjua

You have several problems with your nose. The nasal bone and cartilage appears straight but the tip is overly projecting. You have wide separation of the tip and you also have retraction of the left alar rim from the scar. You will need a small cartilage graft to flatten the alar rim and you will need the decreased projection of the nasal tip by repositioning the medial crura.

Best Wishes,

Gary Horndeski, M.D.

We can raise the columella and remove the dorsal hump easily. That can likely be done even in the office.
The question is, why resist grafting? Grafting will be helpful for the notching you have which can bring the ala down.

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, tensioning of the tip, placement of extended alar contour grafts, among other maneuvers. Graft placement is absolute critical or you will not have a good result. 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

Hello! Thank you for your thoughtful question. Nostril asymmetry, especially when related to childhood trauma or scarring, is a common concern that can be addressed with rhinoplasty. Reducing or shortening the columella can sometimes make nostrils appear more balanced, but it’s important to understand that nostril asymmetry is usually due to a combination of factors — including the columella, the lower lateral cartilages, the nasal septum, and any associated scar tissue from prior intubation.
At the same time, removing a dorsal hump can certainly be combined with work on the nasal tip and columella in a single surgery and is often the standard of care. However, achieving lasting symmetry often requires structural support with cartilage grafting. Grafts are used not only to reshape, but also to stabilize the nasal framework so results remain consistent over time. In some cases, minor adjustments may be possible without grafting, but most experienced rhinoplasty surgeons find that even small asymmetries benefit from strategic graft placement.
So while a “no-graft” rhinoplasty might sound appealing, it may not give you the degree of nostril symmetry you are hoping for, and it could even compromise long-term stability. It's important to point out that grafts are often able to be obtained from the septum or other portions of the nose, such as the dorsal hump. There are also off-the-shelf donor cartilage options available now. So if the concern is obtaining a graft from another part of the body, know that there are other options.
The best approach is a comprehensive open rhinoplasty, where your surgeon can directly address the scar tissue, columella position, and dorsal hump together, and determine whether grafting is truly necessary. I recommend consulting with an experience rhinoplasty surgeon who is comfortable these techniques. They will be able to show you what can realistically be achieved with — or without — grafting in your specific situation.
I hope that answers your question. Best of luck!
Justin Buro, M.D.