Nose is crooked, you can't really tell unless I smile. 1 nostril is higher than the other. What can be done to fix this? (Photo)

 A full set of facial photographs are required to make a determination about being a candidate for a rhinoplasty procedure. Rhinoplasty  is performed for the crooked nose at rest, not upon smiling. The Smile muscles themselves are going to be asymmetrical and one side stronger than the other, so it's normal for the nose to pull to one direction because of this  when smiling. To straighten the crooked nose at rest requires osteotomies placed in the basal bones, a spreader graft placed under the concave side in the midportion of the nose, and a  tip rhinoplasty when the nasal tip cartilages are asymmetric and crooked. For more information and many before-and-after examples, please see the link and the video below

Every nose is different and unique to that individual. If the appearance of your nose concerns you enough to do something about it, it can be improved with a natural artistically performed rhinoplasty. What would be the best option and exact procedure would depend on an in person examination (not just an online consultation) and discussion about desired outcome. Excellent results can be achieved with either a closed or open technique.

Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you exactly what to do and how technically to do it based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of the operative procedure would not be in your best interest. Natural appearing results need to be individualized and what is appropriate for one patient is not necessarily the best for someone else. I would suggest that you find a surgeon with extensive rhinoplasty experience certified by the American Board of Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) or a facial plastic surgeon (otolaryngologist) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, M.D., FACS
 
La Jolla, California

From your one photo and your description, you may be a candidate for a unilateral alar reduction.  This procedure can reduce the larger nostril and bring the base of the nostrils into better balance.  If the bridge of your nose is not bothersome, the nasal bones do not have to be broken.  Seek out a board certified plastic surgeon with extensive rhinoplasty experience.  Best wishes, Dr. Lepore.