Asymmetrical nostrils from cast removal till now. 3 months PO, and it's getting worse. What can be done, and how soon? (Photo)

No before poured nostril photos! WHY? You need revision for a collapsed alar rim on the left side at any time. I might use cartilage grafts from your ear to reconstruct the collapse. 

Hello Laura_Lee, There are a variety of options to modify your nostril asymmetry in order to improve the cosmetic appearance as well as likely functional (breathing) impairment you may have on the left.Depending on your individual anatomy following your surgery and keeping your desired outcome realistic, I think getting the nostrils more symmetric is possible.The photos appear to show what we call external nasal valve collapse, with the nostril not being able to support itself.  This can happen after rhinoplasty and it is not predictable whether this will worsen with time, but it is not likely to improve.  Without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of the operative procedure it is difficult for me to guide you exactly.I will try based on the photos.  You would benefit from releasing the scar, as well ascartilage grafting to the left nostril using either an alar batten or alar strut graft to strengthen the nostril margin, which would help treat the depression and asymmetry simultaneously.I always ask patients who are seeking revision rhinoplasty to allow their initial surgeon an opportunity to correct the issue.  If this is not possible, I would suggest you find a facial plastic surgeon certified by the American Board of Facial Plastic and Reconstructive Surgery, or a facial plastic surgeon that you trust and are comfortable with. You should discuss your concerns with that surgeon in person. I know a few ABFPRS members in Virginia if you wish to stay local. I hope this helps. Dr. Scott Shadfar

Thank you for the photos though a full examination and review of your operative note is really needed.  Since your surgeon knows what he did his advice may be most pertinent.  Short of that at the time of surgery, having evaluated the problem in person corrective steps would be taken possibly with the placement of supporting graftsDr Corbin

This is a very difficult question to answer online,  and may also be a challenge when you may be examined in person, but it is clear that you  have some asymmetrical features to your nose.  The left nostril rim seems to be flatter and less supportive than is the right nostril, the base of the right nostril is wider than the more narrowed left nostril base, and as you pointed out there is a notching to the left nostril compared to the right side.Always listen carefully to the advice of the surgeon who performed your surgery, because he or she may still have the best answer for solving your problem.  Cartilage grafts and composite grafts to give you more width and support to the left rim and nostril may be required., but this clearly can't be determined with looking at your photos online.Good luck to you.Frank Rieger M.D.  Tampa Plastic Surgeon