Could a Septoplasty Cause my Once (Mostly) Symmetric Nostrils to Become Uneven?

It looks like your nostrils are a bit uneven with the left smaller than the right.  Typically, the problem stems either from the end of the septum being offline from the midline or the footplate of the lower lateral cartilage flaring out into the airway.  It is a bit tough to tell which (or both) are the problem with you.  If it is just the footplate, an in-office procedure with a long-lasting (or permanent) suture might do the trick.  I would ask your surgeon about it.  Good luck!

 

Colin Pero, MD
 

Yes, it is possible for a septoplasty to created some asymmetry in the nostril openings.  Although the nostril rims are not touched during this procedure, the septum itself can shift position and can push againsts some the cartilage that makes up the tip of the nose.  This can in turn cause the structure which divides the two nostrils (called the columella) to project more into one nostril than the other.  This can be easily corrected with a minor procedure.

A right handed surgeon would peform the surgery through the left side of the nose and the incision on that side can commonly create some swelling and edema at the level of the columella and medial crura on that side (partition between the nose).  If this persists beyond 1 year and you truly had perfectly symmetric nostrils then a small revisional procedure can correct that.  From the photo you submitted the nostril rims themseleves are symmetric...so it is truly the medial portion of the left nostril that is slightly too full giving the appearance of assymetry.

It is possible to have asymmetry of the nostrils if a septoplasty was performed that involved the most outward portion of the septum.  This is rarely done. 

It is possible but you will have to compare before and after photos to be sure.  Most often, patients have uneven nostrils to begin with but did not pay as much attention to nostril symmetry before the surgery. Also, it looks as though the lower portion of the left tip cartilage is more flarred than the right and this has caused your nostril to look asymmetric. 

The photos show that there is some asymmetry of the columella where the septum is pushed slightly into your left nostril. While this may have been present before your original surgery, sometimes, based on what was done, and how the healing occured, the bottom or the most distal part of the septum may have healed in this position and caused a little asymmetry.  I would encourage you to look at your old photos if you have any. It would have to be the same type of photo you have posted to make an accurate comparison.

If this bothers you or is causing some concern, it can be corrected by moving that part of the septum to the midline and anchoring in the midline so as to make your columella and the nostrils symmetric.

Good Luck

 

Septoplasty is a procedure to straighten the septum which is the cartilage partition between your two nostrils.  The septum extends all the way to the front of the nose just behind the bridge of skin (columella) that separates your two nostrils.  If the septum is dislocated from the midline strucure that it sits on during surgery then you can have an asymmetry of the nostrils after surgery.  From the limited view of your nose it appears that your septum may be pushing the medial crural footplate over into your left nostril or it was displaced at the time of surgery.  The other possibility is that you are noticing things more and that you have had some pre-operative asymmetry that is now more obvious as you more closely inspect your nose.  Either way, you should discuss this with your surgeon, have your nose examined to determine what is going on and allow your surgeon an opportunity to explain and/or correct this issue. 

By definition a Septoplasty modifies (moves / changes) the nasal septum for either functional or cosmetic reasons. An intra-nasal examination would readily show why you have an asymmetry of the nares. From the limited "worm's eye" view you provided you APPEAR to have a midline septum and an over prominence of your ? left foot process of the lower lateral alar cartilage (which could be corrected quite easily) along with a prominent inferior turbinate.

Ask your ENT surgeon for his suggestion. He appears to have done a nice job placing the septum in the midline there is no reason to doubt he would a good job in making your nares more symmetrical.

Dr. Peter A Aldea

The left nostril is smaller than the right due to one of the following (picture is very samll and difficult to see):


Weak, displaced and crooked anterior septal cartilage

Displaced crural foot tip cartilage on the left


You should have a few consults with well experienced Rhinoplastry surgeons for further evaluation and recommendations.

Postoperative septal deviation can manifest as nostrils of unequal size. Your septum pushes your columella to the left, making your left nostril seem smaller.

I have occasionally seen recurrent septal deviation in a septum that was corrected--after the crooked part is removed, the internal stresses in the septum are disturbed and the remainder then deviates.

It is also possible that this asymmetry is something that you have only now noticed.  Check old photos to be sure.

But don't worry--your problem is easily fixed.