What can I do to address my asymmetrical nose when smiling? (photo)

Based on your photo, you appear to lift your left cheek more than your right when you smile. That can result in a slightly different appearance of your nose from the right side to the left side. Given this information, I would recommend no intervention. Thank you for your question, and I hope this is helpful. Sincerely, Dr Joseph

As you mentioned you see difference in your nose level while smiling. You can have an more active muscle on one side. You can try injection of Botox on that muscle to achieve symmetry.

It appears that the muscles lifting the cheek on the left are stronger than the muscles on the right. A rhinoplasty would not be able to change the strength of these facial muscles. Also, botox is not generally used on these muscles because they will cause droop which is not desirable. There is a surgery to narrow the alar flare called a Weir excision, but this will permanently make a change which will be seen whether you are at rest or smiling. This means the cheek muscles will still pull on the left nostril when you are smiling. It may sound unusual, but you can practice relaxing the muscles of the face (this is called biofeedback therapy) and hopefully it could decrease the strength of the muscles on the left.

All people have a symmetrical faces.
The human brain is accustomed to seeing peoples faces as being a symmetrical.
Since you’ve never seen as symmetrical face, if you see a computer generated symmetrical face, you may find that they have an odd unfamiliar appearance.
The base line a symmetry is primarily determined by the skeletal structure. Soft tissue coverage tends to be far more consistent.
During embryological development, the two sides of the face develop independently from each other and eventually fuse in the midline.
Midline structures tend to not be highly symmetrical because they are in the midline.
Most of the symmetry tends to be in the rest of the face.
Your face is normal, and does not need treatment.
Your nose also looks fine and I see no need for intervention there either.
Best,
Mats Hagstrom, MD