Uneven Nostrils
All cosmetic surgery involves risks and individual results vary. Cosmetic surgery is a serious decision. Decisions about whether to proceed should be made after careful consideration and following at least two consultations with a qualified medical practitioner.
Nostril asymmetry — where the two nostrils differ in size, shape, or position — is common and can arise from a number of anatomical causes. Some degree of facial and nasal asymmetry is present in virtually everyone, and complete symmetry is not a realistic surgical goal. However, where asymmetry is significant and a patient is seeking assessment, the underlying cause should be carefully evaluated before any intervention is planned.
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Causes of Nostril Asymmetry
The nostrils are shaped by the lower lateral cartilages — divided into medial crura (the central limbs within the columella) and lateral crura (the outer limbs forming the alar sidewalls) — and by the position of the caudal nasal septum. Asymmetry can arise in any of these components:
Surgical Treatment
The approach to correcting nostril asymmetry depends on the underlying cause identified at assessment. Common surgical techniques include:
- Caudal septal repositioning or reconstruction — where a deviated caudal septum is the primary cause, it is repositioned to the midline or, if severely deformed, removed and reconstructed with a straight piece of cartilage. The new cartilage is secured with sutures to maintain the corrected position.
- Columellar strut graft — a straight cartilage graft placed between the medial crura to correct flaring or asymmetry of the columella and provide a stable symmetric midline foundation.
- Lateral crural strut grafts — to reposition and support the lateral crura where one alar rim sits higher or is less well-supported than the other.
- Composite grafts or rim grafts — where one alar rim is retracted upward, composite grafts of cartilage and skin from the ear can be used to lower and support the rim.
As with all rhinoplasty, perfect symmetry is not a achievable goal — the aim is meaningful improvement within the context of the patient’s overall facial proportions, with realistic expectations established at consultation. Two consultations are always required before any rhinoplasty proceeds.
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Dr Roth’s Clinical Perspective
Nostril asymmetry is present to some degree in almost every nose, and the consultation distinction I make is between asymmetry that is noticeable in normal social interaction and asymmetry that is only apparent on careful examination. Most patients presenting with nostril asymmetry have not been told why it exists — they have been told it is there, but not what is causing it. Identifying the specific anatomical contributor — septal deviation, medial crural flare, alar rim retraction, lateral crural asymmetry — determines whether surgery can address it and what approach is appropriate. Asymmetry that arises from a deviated caudal septum is corrected differently from asymmetry from unequal medial crura, and the distinction matters for the surgical plan.
— Dr Jason Roth, MBBS, FRACS (ORL-HNS), IBCFPRS
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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