Uneven Nostrils After Plastic Surgery, Worth Having Revision Rhinoplasty to Even Out? (photo)

(Added more photos)I had plastic surgery, I'm 8 months post op now. My nostrils were slightly asymmetrical before surgery, but the rims of the nostrils were even then. Now after surgery the right nostril rim looks pinched upwards. I told my doctor I feel uncomfortable, but he insists that if he was in my shoes he wouldn't do revision surgery. He says he thinks the difference is hardly noticeable and that revision surgery might not solve or even worsen the problem. What should I do? Thanks!

Doctor Answers 6

Treating alar retraction

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You do appear to have slight right alar retraction. It's hard to say from the photos submitted but there may also be a component of a hanging columella as well. These issues can be treated with revision surgery, but a lot depends on how much it bothers you. It's too early to have a revision anyway -- I'd suggest waiting until at least a year after surgery since your nose will continue to evolve over time.

Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Uneven Nostrils 8 Months after Rhinoplasty

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It does appear you have slight retraction of the nostril rim which can be improved with placement of a small alar rim cartilage graft. A hanging columella may also be present. Both these procedures are relatively easy; you will have to decide if you want to have a revision. A second opinion may help to clarify your options before making that decision.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Uneven nostrils

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Based solely on the phots you posted, I would have to admit with your surgeon.  Everyone has some slight asymmetry and this is normal!

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Uneven nostrils after rhinoplasty

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Hi. I don't see any preop photos so it's difficult to say whether this problem was present before surgery. I notice the slight notching of your right nostril rim but agree with your surgeon that it is minimal. It can be improved by inserting a small cartilage graft from inside the nostril. This is a relatively minor rhinoplasty revision issue. Ask your surgeon about this and if he/she refuses, then you might also seek out a board certified plastic surgeon who is very experienced in revision rhinoplasty for a second opinion if it still bothers you.Good luck!

Uneven Nostrils - Alar rim retraction

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Almost without exception individuals have some element of uneven nostrils.   Patient before and after pictures  from underneath, known as the "worm's-eye view,"  will often reveal that some asymmetry existed before the surgery.  Often times, nostril asymmetry will improve with surgery. 

The most common maneuver in surgery to narrow and shape the tip removes volume from the cephalic portion of the upper lateral crura.  This procedure runs the risk of causing the nostril edge, or alar rim to retract.

In general, unless problems are severe, secondary nasal surgery carries  more risk than benefit because the surgery and healing tends to be less predictable than the original procedure.  Based on this photo, your doctor is probably right not to recommend further surgery to address the position of the rim of your nostril. 

Donald I. Altman, MD
Orange County Plastic Surgeon

If it bothers you, fix it!

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Dear CelesteJoy,

Minor asymmetries can be easily corrected with filler injections, so why live with something that you are unhappy with?  Surgical corrections of this problem was not be as precise as injections.  Although, filler injections used for rhinoplasty refinement are used "off-label," they are safe and common.  Injections of filler can yield precise and immediate results with little or no "downtime."  They tend to last 9-10 months, but can last even longer when placed within 6 months of a surgery as they get incorporated into the healing process.  Injections with hyaluronic acid fillers such as Restylane or Juvederm can be reversed or modified as per your aesthetic sensability. 

Best of luck in your decision-making!

Michelle R. Yagoda, M.D.

Michelle R. Yagoda, M.D., P.C.

1025 Fifth Avenue

New York, NY 10028



Michelle R. Yagoda, MD
New York Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.