Uneven Nostrils After Rhinsepoplaty Surgery? (photo)

I had a rhinoseptoplasty on 4/2012 to fix a deviated septum & reduce the projection of my nose as I felt it appeared pointy/too long from the profile. 12/4 I had a revision done b/c the incision area had a step off & my R nostril looked weird. My surgeon thinks nothing is wrong w/ my R nostril. I DO NOT agree! I've seen lots of nose jobs & the nostrils r never this uneven unless poorly done. So saying nothing is symmetrical doesn't fly, esp when my nose was more symmetrical to begin w/. Thoughts?

Doctor Answers 6

Nostril Asymmetry after Rhinoplasty


Your original picture is difficult to see as it is a straight forward photographic view and not of the underneath of the nostrils. Asymmetry may be fixed with surgery however I would suggest a full year of healing before looking into a second opinion. This will allow the proper time for all of your swelling to completely dissipate. Natural asymmetry is common prior to surgery and can usually be fixed during the procedure. nostril asymmetry created from a procedure is much more noticeable. Best regards, Michael V. Elam, M.D.

Orange County Facial Plastic Surgeon
5.0 out of 5 stars 210 reviews

Nostril Asymmetry after Rhinoplasty #nosejob

This is a tough one because It is so hard for any of us to know what your nose was really like prior to surgery. You expressed not wanting to hear that everyone has some asymmetry, but they do!!! It is what it is. Now, that is not to say that your asymmetry can be worse now but certainly everyone is uneven from side to side. I do not ever revise a nose for about one year. The scars need to settle and soften and the swelling needs to resolve. There are a few things that can be done to correct asymmetry of the nostrils that is appears you are pointing out in your last photo with the red circle. I do agree that in the right case alar resections can give more evenness to the nostrils. However, they are usually used in patients who have nasal alar flaring or widening of the nasal base. What I see that you point out looks to me more like alar retraction. I do not know if your surgeon placed them, but I use alar rim cartilage grafts in almost every single Rhinoplasty because there is always some inherent change of the alar with the tip work, and I have found that alar rim cartilage grafts give some support that will fight the retraction and help maintain some of the round shape to the ala. Even when I use them many, many patients have asymmetry to the nostrils. I know you are not happy and I am sorry about that. You do need to be open with your surgeon and decide if one, the revision that you want is even possible and two, can that surgeon provide you with the result you need? My advice is to first give your surgeon a chance and then if you are not happy seek second, third, fourth or however many opinions you need thereafter.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 49 reviews

Nostril Asymmetry after Rhinoplasty

      Alar base resection can be performed to further reduce the right nostril, but you should wait until at least 6 months postop.  Your nose is much improved over the first surgery, but it is difficult to comment about your original nose as you only have a front view without visualization of nostrils.  Whenever a tip is raised, nostril asymmetry is always unmasked.  You should know that virtually no one has symmetric nostrils, and I have had to revise much greater asymmetry than you have now.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Nostril asymmetry

One of the things that I try to point out to my patients is baseline asymmetry. Preoperatively, you had substantial asymmetry between your nares (the 2-dimentional opening of the nostrils) with the right much larger than the left. This will not change with a traditional rhinoplasty, as skin must be removed (usually where the ala attaches to the face) or a filler placed to reduce the circumference of the larger naris. Your surgeon made an excellent attempt to provide greater symmetry of the soft triangles and tip-alar junctions. Looking up the right nostril of your after picture you can just see the lateral crura. Look how thin that nostril skin is next to it compared to the left nostril. This was present preop, but you didn't see it because the nostrils pointed down. The rotation of your tip exposed and accentuated your baseline asymmetry. A simple filler or rim graft may alleviate this.

John C. Ferguson, MD
Honolulu Facial Plastic Surgeon
3.9 out of 5 stars 8 reviews

Uneven Nostrils After Rhinsepoplaty Surgery?

Because it has only been 1 month since your revision, I would recommend that you wait for another 5 months before you consider another revision.  If you are not happy with your surgeons answers, you may want to consider a second opinion with another Board Certified Plastic Surgeon.  Good luck!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 107 reviews

Uneven Nostrils After Rhinsepoplaty Surgery?

Many thanks for the question. What I can see that the secondary correction for poor work first time has ended reasonable well since even the most normal looking person will have some nominal asymmetry. One must try at least to come out with the thought of his nose. Nose is one surgery that hooks a person for greeter and greater perfection which perhaps is unachievable. I think you should now be happy with the surgeon and his result.

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.