Caudal septum deviation after septoplasty? (Photo)

The picture looks suspicious for a caudal septal deviation. There could be some contribution from the lower lateral cartilage footplate as well. The only solution to correct this is a reoperation. I would recommend discussing this with your second surgeon. Keep in mind, however, that nostril asymmetry, to some degree, is extremely common. Temper your expectations and do not expect absolute perfect symmetry.

It's possible this is a caudal septal deviation, which would not usually be addressed in a traditional septoplasty (the first one you had) and may not have been addressed either in your 2nd surgery... but it could also be due to the position of your lower lateral cartilage/medial crural footplate. It's too hard to tell from photos alone, get an examination by a facial plastic surgeon.

That said, I would not recommend further surgery based on your singular view of your nasal base. The nasal base view is the least important view of your nose. If you are having severe nasal obstruction, that is a different issue. Since you have had a septal perforation, and since that is presumably repaired, any further surgery on your nasal septum would be very difficult and possibly risky. Thank you for your question. Sincerely, Dr Joseph