How can my nostril asymmetry caused by rhinoplasty be fixed with revision? Can anyone tell me what may be causing it? (photo)

Firstly, it appears your nostrils started off asymmetrical.  Your pre-op photo shows a difference between the two sides.  This may be something you never noticed but after surgery you may have paid closer attention to the nose.  It may be that the difference increased following surgery.  If this was the case, most likely it was due to some change made to the shape and/or position of the tip cartilages.  It appears your tip is narrower and more refined.  Like all improvements in the nose after rhinoplasty there can be an associated imperfection.  If you feel the nostril asymmetry is really bothersome and troubles you enough for you consider revision, I would first bring this up with your surgeon.  It is not an easy thing to correct.  In my judgment, the nostril difference does not stand out significantly and does not distract from your overall attractive nose and face.  Hope this helps.

 A revision rhinoplasty can be entertained at least one year after the primary rhinoplasty. The nose itself is crooked, therefore osteotomies  of the nasal bones are  required.  A spreader graft composed of the patient's own cartilage will need to be inserted underneath the concave upper lateral cartilage the midportion of the nose.  The hanging columella needs to be reduced as well. A composite skin graft or an alar rim graft is required to give the nostrils more symmetry. Look for a surgeon who has dedicated a significant component of their practice to the discipline of rhinoplasty, since revisions are harder than a primary procedure.

It appears that you should have good reason to trust your primary rhinoplasty surgeon.... your result is quite niceyou began with some nostril asymmetry and ended with some as well..... it appears that you have a bit of left alar retraction compared to the right.... this is usually due to deficiency or malposition of the lateral crus of your lower lateral cartilage, scarring/retraction of the nostril lining or a combination of factorsretracted ala are difficult to fix and require careful consideration particularly in the face of an otherwise reasonable result....good luck

Dear alli_104,

Thank you for your clinical post and
again sorry to hear of your unsatisfactory aesthetic outcome. The overall appearance of your nose at this
phase of healing is actually more pleasing than your pre-operative view in many
respects. The pre-operative view shows
that the left nasal alar base was slightly higher than the right to begin
with. Your nose pre-operatively was
somewhat dominant, long, over projected with a bump. The left nasal view had more nostril show,
meaning a slight left alar retraction compared to the right.

Unfortunately, although many aspects
of your nose and nasofacial balance has been improved, the left nostril is
asymmetrical compared to the right with an exaggerated nostril show and hanging
columella. This allows people to look up
the left nostril from a side view compared to the right. The labial columellar angle is improved, the
length is appropriate, the nasal projection is good and the nasal bridge has
been corrected. Unfortunately, the
position and shape of the ala, which is asymmetric to begin with has
exaggerated the left nostril retraction and show.

This largely has to do with the
primary repositioning and restructure of the lower lateral crura of the lower
lateral cartilages. The tip and the support
of the tip and the nostrils is supported by a three-legged chair; two legs
forming the support of the nostrils and the central legs the columella. When one leg of the three-legged chair is slightly
symmetrical, the chair tilts and you have a tilting chair or retraction of the
left ala.Restructuring of the
cartilages with cartilage grafting likely from your conchal cartilage or ear
cartilage will provide the support to bring down the left nostril and correct
the nostril show. Secondary rhinoplasty is always more
risky and dangerous than primary rhinoplasty as soft tissues don’t heal the
same way after surgery has been performed, but I think there’s a high
probability of improving some of the concerns that you have.

Additionally, the nasal tip and
length of the nose can be lengthened with septal strap elongation and grafting,
but your expectations needs to be realistic and computer imaging needs to be
performed in order to show the range of improvements that will likely occur.

While you’re waiting certainly
injection rhinoplasty can lower the alar rim and provide some relief from the
asymmetry while you’re waiting for resolution of the healing from surgery and
deciding if revision rhinoplasty is right for you.

I hope this information is of some
assistance and best of luck.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto