Can the appearance of my deviation and asymmetrical nostrils be improved with filler? (photos)

Hello and thank you for your question. You have a very difficult problem to fix, and honestly a revision surgery is your main/best option! You have an obviously deviated nose with asymmetry to the tip and nostrils after a prior rhinoplasty, as you mentioned. In order to make your nose appear straighter with fillers, you would need to try to mask the crooked nose by injecting filler primarily to the side opposite to the deviation to fill in that area- this would not fully look straight, and in the process would make your entire nose appear substantially wider, which I promise you would be very unhappy with. Your asymmetry and deviation is due to a combination of the underlying structure established during your initial rhinoplasty and the strong contractile/distorting forces of scarring after rhinoplasty (which can unfortunately happen after any surgery, but is particularly devastating and noticeable after rhinoplasty). There are actually certain maneuvers which can be performed during rhinoplasty surgery to prevent such retraction and distortion to minimize the likelihood of these asymmetries, but the majority of surgeons either are not aware of these maneuvers or do not perform them. Given you've previously had a rhinoplasty, and there is no doubt extensive scar tissue present throughout your nasal dorsum and in your tip/nostrils, so fillers would not be able to adequately overcome the scarring, and only an open rhinoplasty can best address your issue.

In addition to addressing your aesthetic concerns, your septal cartilage (or an off-the-shelf alternative) would be harvested (removed) and turned into multiple cartilage grafts, which would then be secured into different areas of your nose for structural support, including in the columella (middle bottom portion of your nose between your nostrils) to really reinforce the tip and alae, and prevent distortion and asymmetries from re-forming. As you've already had a rhinoplasty, likely your septal cartilage has been used already, so we'd use an off the shelf alternative (MTF cartilage).

The open approach is very effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery. I would only recommend going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible.

Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos and description provided.

Dr. Donald Groves, our expert facial plastic surgeon, has extensive training and experience with complex rhinoplasty surgeries, so I’d recommend for you to come see him (or another plastic surgeon who is extremely comfortable with rhinoplasties) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Emer

If you are concerned by an asymmetrical nasal tip appearance along with asymmetrical nostril heights, depending on your examination, microdroplet Silikon-1000 injections may be considered for nostril lowering and for restoring volume to your tip for a more symmetrical nasal tip appearance. I hope this is helpful! Sincerely Dr Joseph

Good Morning! Filler can be helpful in the nose to camouflage certain asymmetries. The important thing to know about filler is that they don't last more than 8-12 months on average and can cause damage to the nose. Although very uncommon, the nose is vascular and filler can enter one of the vessels and cause occlusion with subsequent tissue loss. I find filler to be most helpful for the profile view - for example, camouflaging a hump. On the front view, it is more tricky. In your case, you could add some on the left side, but it would increase the width. It is less effective for the nostrils. There are always tradeoffs. A revision rhinoplasty would give you the best chance of improving your asymmetries. Hope this helps!