What can be done for my extremely uneven nose of just one side? (Photo)

Question

I have a problem with the right side of my nose. It doesnt seem to have any cartilage and therefore is extremely wider and uneven than the other side. I don't know who to go to for some answers if it can even be fixed.

Darrick E. Antell, MD, FACS · Answer

Hello! Without the benefit of an in person exam, you may be a candidate for in office fillers to give a straighter appearance.  I have successfully done that before and the results last many years as the area is static.  The filler I use is also reversible if for some reason you don’t like it.  No recovery and a much lower price point make this a frequent first choice.  Plus you can participate in the process by periodically looking in a mirror during the procedure.  The other alternative is a surgical procedure. 
*Opinions stated here are only opinions. They are not based on a clinical examination which is recommended. They are not based on a clinical exam which is recommended.*

Afshin Parhiscar, MD · Answer

Dear Cynthia Nasal asymmetry is a common complaint and can generally be improved with rhinoplasty. Certain types of asymmetry including facial asymmetry with differences in the vertical height of the left or right side of the face and specially vertical  differences between the positioning of the left and right ala in terms of height cannot be fully corrected. In these cases improvement is your best option. If it's reassuring, most other people Will not recognize this type of asymmetry.  Look for an experienced and well-trained plastic surgeon who is certified by the American Board of plastic surgery, see more than one consultation and make a well informed decision.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  Your pictures do demonstrate nasal asymmetry.   Based on your
photograph, you may benefit from spreader grafts which can help improve symmetry and a tip refining rhinoplasty. You may also benefit from a conservative dorsal hump reduction.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. The most important
aspect is to find a surgeon you are comfortable with. 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

Evan Ransom, MD, FACS · Answer

Thank you for the question and the photos. Improvements in nasal symmetry can be achieved with a comprehensive rhinoplasty, including alar base modification (nostril reshaping). It is important to note that in many cases of nasal asymmetry, there is concomitant facial skeletal asymmetry. This cannot be corrected with rhinoplasty and may require complex dental or orthognathic procedures. Best of luck moving forward!

Steve Laverson, MD, FACS · Answer

Yes, your nasal asymmetry can be resolved partially or completely by rhinoplasty.  Underlying bone and cartilage determines shape and size of the nose.  Rhinoplasty is an operation upon this framework to re-size, re-shape, and re-build the nose into a feature that matches your desire.  Overlying skin re-drapes over the new framework so it appears natural, like nothing ever happened.

Daniel Barrett, MD · Answer

Dear cinthiazavala2010,it is hard to tell without an examination. I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Donn M. Hickman, MD · Answer

Thank you for your question.  It would be advisable to have your nose examined in order to determine what the best course is. All noses have some natural asymmetry either bridge alignment,  nostril shape, flow of the nose as it takes off from the forehead, and in the flow of the septum. .  Sometimes one can make the nose look better, smaller, and straighter, but not perfectly symmetric. The general fullness of your nose draws attention to the nostril difference. A reduced nose with narrowing of the bridge would redirect the focus on the center of the nose. The lower position of the right nostril can be directed more toward the center but not perfectly matched to the left.  Any attempt to place an outside scar around the right nostril and suture the nostril in a new higher position will be a recipe for a large external scar.  I have seen this in a number of cases which present to the office.  Chasing a low or wide single nostril with external skin suturing is not the way to go.  The surgeon will try to perform all the surgery from inside and closer to the columella. A more shapely contoured nose will look better, even though it may not be perfectly symmetric. We only resort to wide external scars for flat wide broad nostrils.  Best wishes.

Charles W. Guy II, DO, FAOCO · Answer

Cinthia,
You do have asymmetry to your nose but not from lack of cartilage on the right but rather twisting of the cartilage.  By the looks of the outside of your nose, you likely also have deviation (a shift) of your septum insider your nose to the right causing some difficulty breathing on your right.  A septorhinoplasty could improve the outward appearance of your nose and improve breathing.  You would likely need some reconstruction of the cartilaginous dorm with some spreader grafts.   The best way to know would be to have an in-office evaluation with a surgeon that comfortable with rhinoplasty and functional rhinoplasty.

William Portuese, MD · Answer

A thorough examination of the nose is required to make a determination of what is causing the crooked nose problem. Is it excess cartilage on one side, thicker skin on one side, or twisted nasal bones? Each one of these issues are treated differently with a rhinoplasty procedure. Thick skin in the tip of the nose will prevent refinement in that area. For many examples of twisted nose repair in our practice, please see the link and the video below

Myriam Loyo, MD · Answer

Hi Cinthia,  thank you for your question and photos.
I can see the difference in the sides of your nose in your photos. I suspect your septum might be shifted inside changing the shape of the sidewalks. But truly you need an exam in person to fully determine why there is a difference and what can be done to improve the shape.
I suspect rhinoplasty can help you better match both sides of your nose.
Good luck

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