Nostrils After Rhinoplasty: Is Asymmetry Normal? When Should You Be Concerned?
By: Prof. Dr. Gediz Murat Serin
I am Prof. Dr. Gediz Murat Serin. Since 2006, I have performed the vast majority of both primary and revision rhinoplasty cases at my clinic. Over time, I’ve observed a trend: while patients used to focus primarily on the overall shape of the nose from the front or side after surgery, now the appearance of the nostrils has also become a major aesthetic concern.
High-resolution photos and selfies shared on social media have significantly shifted this perception. Even the smallest differences in nostrils have become more noticeable.
Of course, as surgeons, we strive to make the nostrils as symmetrical and natural-looking as possible. However, as we always emphasize, perfect symmetry can never be guaranteed due to human anatomy. Our goal is to provide a natural appearance that is harmonious and functional with the rest of the face.
In this article, I explain the reasons behind nostril shape differences after rhinoplasty, the healing process, and when you should seek further evaluation.
Why Does Rhinoplasty Affect the Nostrils?
The nostrils are shaped by the nasal alae (alar structures) surrounding the tip of the nose. Procedures performed during rhinoplasty — especially tip narrowing, alar base resection, cartilage grafting, or septal corrections — directly affect these structures.
Even the slightest surgical adjustment in this area can make a significant difference both aesthetically and functionally. Therefore, nostrils are handled with particular sensitivity during surgical planning.
There is a common misconception about rhinoplasty: patients often believe the nose is sculpted from the outside like clay, molded into the desired shape. In reality, it’s a much more technical and complex process.
Rhinoplasty is not a superficial cosmetic procedure — it is a planned reconstruction of internal structures such as bone, cartilage, and soft tissue. During surgery, cartilages are reshaped, some structures are excised, and new support lines are created with sutures. Every incision and every suture creates a specific tension vector. The cartilage grafts we place can change shape over time depending on the body’s response, and in rare cases, they may partially dissolve. Likewise, varying tissue reactions during healing can lead to minor asymmetries.
In short, we are not sculpting a statue; we are building a functional, biological, and dynamic structure. The final outcome is shaped not only by the surgery but also by the body’s natural healing response.
Is Asymmetry Normal in the First Weeks After Surgery?
Asymmetry observed in the nostrils during the healing process is often temporary and expected. The main causes of these early differences include:
- Asymmetric swelling (edema): Each side of the nose heals differently, which may temporarily make the nostrils appear uneven.
- Suture line tension: After alar base surgery, varying tension levels at suture sites can lead to temporary asymmetries.
- Effects of splints or packing: Internal supports may influence the angle and position of the nostrils.
It can take 6 to 12 months for the nose to reach its final shape. During this time, it’s important to be patient and not interpret early differences as permanent.
Causes of Permanent and Noticeable Nostril Asymmetry
If a distinct difference between the nostrils remains after healing is complete, several structural factors may be responsible:
- Natural facial asymmetry: No human face is perfectly symmetrical. As a result, the nostrils may not be identical.
- Insufficient alar support: Weak cartilage in the nasal ala can lead to collapse or deformity.
- Excess tissue removal: Excision performed for aesthetic balance may occasionally have adverse effects.
- Scar tissue (fibrosis): Post-surgical scarring can cause retraction in the nasal wings.
- Deviation: A crooked nasal septum may affect the position and openness of the nostrils.
Aesthetic Perception and Psychological Impact
After rhinoplasty, patients become highly attentive to every detail of their nose, especially in high-resolution images or close-up shots. This can sometimes lead to negative body image or unnecessary anxiety.
It’s important to reiterate that we work diligently to equalize the nostrils as much as possible, but due to the natural structural asymmetry of the human face, perfect symmetry can never be guaranteed. What truly matters is that the nose appears natural, aesthetic, and functional in harmony with the overall facial structure.
When Should You See Your Surgeon?
It’s advisable to schedule a follow-up appointment if the following conditions are observed:
- Persistent asymmetry or collapse beyond 6 months post-op
- Inadequate airflow through one nostril
- Visible weakness or collapse of the nasal wing
- Significant size difference between the two nostrils
Such issues can often be addressed with revision rhinoplasty when necessary.
Follow-Up, Patience, and Expert Assessment
Each individual heals differently. Skin type, age, surgical extent, and prior procedures all influence the result. Therefore:
- Differences observed in the first 3–6 months are usually temporary.
- The final shape of the nose is established within 1 year.
- This period should be closely monitored by a specialist to avoid unnecessary interventions.
Conclusion: Nostrils and Rhinoplasty Should Be Evaluated Together
The symmetry of the nostrils after rhinoplasty is important not only for aesthetics but also for functional success. However, evaluations must consider anatomical limitations and individual differences.
While shaping the nostrils, we as surgeons aim to ensure both aesthetic harmony and healthy airflow. Realistic expectations and a patient approach to healing are crucial for overall satisfaction.
