Nostril Asymmetry Correction Rhinoplasty with Rib Cartilage
- Dr. Chayoung Kang
- 2025년 2월 19일
- 5분 분량
This case reviews nostril asymmetry correction rhinoplasty in a patient with severe nostril distortion, right-sided nostril stenosis, pinched nasal tip, collapsed alar cartilages, scar contracture, airway obstruction, and uneven nasal base structure after multiple previous surgeries, including alar base reduction and philtrum shortening. Surgery focused on rib cartilage septal reconstruction, septal extension grafting, Z-plasty stenosis release, scar tissue release, internal nasal valve support, dermal grafting, alar cartilage reconstruction, dorsal contour correction, and functional airway improvement.
Author: Dr. Cha-Young Kang
Clinic: NoseLab Clinic
Published: 2025
Last Updated: 2026
Introduction
Hello, this is Dr. Cha-Young Kang of NoseLab Clinic.
This case involves nostril asymmetry correction rhinoplasty in a patient who developed severe nostril asymmetry and right-sided nostril stenosis after multiple previous surgeries.
The patient had undergone prior procedures including alar base reduction and philtrum shortening. Over time, scar contracture, inflammation, and tissue loss contributed to both functional and aesthetic problems.
The surgery was performed using a closed rhinoplasty / endonasal approach with structural reconstruction. The goal was to improve nostril symmetry, release stenosis, reinforce the nasal airway, and reconstruct the collapsed lower nasal framework without unnecessarily lowering or lengthening the nasal bridge.
Why Nostril Asymmetry Correction Rhinoplasty Was Needed
Preoperative design consultation photos were reviewed from the frontal, side, oblique, and nostril views.
The patient wanted correction focused on airway function and nostril symmetry rather than major changes to nasal bridge height or length.
Preoperative Issues
The main findings included:
Significant nostril asymmetry
Right-sided nostril stenosis
Pinched nasal tip
Collapsed alar cartilages
Wide and uneven nasal structure
Airway obstruction
Scar contracture after previous procedures
History of alar base reduction and philtrum shortening
Tissue loss and inflammation-related changes
These findings suggested that the case required structural reconstruction and stenosis release rather than simple nostril reshaping.
Preoperative Structural Assessment
Frontal View
The frontal view showed visible nostril asymmetry, uneven lower nasal structure, and a pinched nasal tip.
Side View
The side view showed altered lower nasal support and imbalance around the nasal tip and columella region.
Oblique View
The oblique view showed asymmetry of the lower nasal framework and irregularity related to scar contracture.
Nostril View
The nostril view showed right-sided nostril narrowing and asymmetry of the nostril openings.
Because the right nostril was narrowed by stenosis and scar contracture, functional correction was required in addition to external shape correction.
Surgical Plan for Nostril Asymmetry Correction Rhinoplasty
The surgical plan included structural reconstruction, functional stenosis correction, and aesthetic refinement.
Step 1: Structural Reconstruction
Autologous rib cartilage was used to rebuild the septal foundation.
A septal extension graft was used to support the nasal tip and improve nostril height symmetry.
Because the alar cartilages were collapsed, structural support had to be rebuilt before nostril shape could be corrected.
Step 2: Functional Stenosis Correction
Z-plasty was performed to release the right-sided nostril stenosis.
Scar tissue was released to reduce contracture and improve the narrowed nostril opening.
Internal nasal valve support was reinforced to help reduce airway collapse.
Step 3: Aesthetic Refinement
Dermal grafting was used to improve soft tissue coverage and soften the pinched nasal tip.
Rib cartilage augmentation was used for dorsal contour support where depression was present.
Lateral osteotomy was performed to refine width asymmetry of the nasal bridge.
The surgical plan was designed to address nostril asymmetry, airway narrowing, scar contracture, and lower nasal support together.
Surgical Execution and Key Maneuvers
Structural Rebuilding
Rib cartilage grafting was used to reconstruct the midline support structure.
Septal extension helped improve nostril balance and nasal tip support.
Functional Airway Support
Z-plasty was used to release the stenotic right nostril.
Scar contracture was released, and nasal airway support was reinforced to reduce narrowing.
Alar Framework Reconstruction
The collapsed alar cartilages were reconstructed to improve lower nasal support and nostril shape.
This step was important because nostril asymmetry was related to both scar contracture and cartilage collapse.
Tip and Dorsal Refinement
Dermal grafting helped soften the pinched nasal tip.
Dorsal depression was corrected with rib cartilage augmentation, and lateral osteotomy helped improve width asymmetry.
Postoperative Results
Frontal View
From the frontal view, nostril asymmetry improved after septal reconstruction, alar cartilage support, and scar release.
The pinched nasal tip appeared softer after dermal grafting and lower nasal framework reconstruction.
Side View
From the side view, the nasolabial angle appeared more balanced, and nasal tip projection improved after rib cartilage support.
The overall profile appeared smoother after dorsal contour correction.
Nostril View
From the nostril view, right-sided nostril narrowing improved after Z-plasty and scar release.
Airflow improved after stenosis release and internal nasal valve support.
Structural Outcome
The alar framework was reinforced, and the lower nasal structure appeared more balanced after reconstruction.
Because this case involved multiple previous surgeries, scar contracture, tissue loss, and stenosis, the outcome was planned within the limits of tissue flexibility, remaining cartilage, scar condition, and healing response.
Surgeon’s Commentary
Severe nostril asymmetry or nostril stenosis after alar base reduction or philtrum shortening cannot usually be corrected by surface adjustment alone.
When scar contracture, tissue loss, cartilage collapse, and airway narrowing are involved, reconstruction must address both the external nostril shape and the internal airway structure.
In this case, autologous rib cartilage was used to rebuild septal support and reinforce the lower nasal framework. A septal extension graft helped improve nostril height balance and nasal tip support.
Z-plasty was used to release right-sided nostril stenosis. Scar tissue release and internal nasal valve support were also included to improve airway function.
Dermal grafting helped soften the pinched nasal tip, while rib cartilage augmentation and lateral osteotomy addressed dorsal depression and width asymmetry.
This case shows that nostril asymmetry correction rhinoplasty should be planned as a combined structural, functional, and soft tissue reconstruction procedure when stenosis and scar contracture are present.
FAQ
What causes nostril asymmetry after previous surgery?
Nostril asymmetry after previous surgery may occur due to scar contracture, tissue loss, alar cartilage collapse, septal deviation, uneven healing, or excessive tissue removal during prior procedures.
What is nostril stenosis?
Nostril stenosis refers to narrowing of the nostril opening. It can occur after surgery, trauma, inflammation, or scar contracture and may cause visible asymmetry and breathing difficulty.
How is nostril stenosis corrected?
Correction may involve scar release, Z-plasty, cartilage grafting, internal nasal valve support, and soft tissue reconstruction. The exact method depends on the cause and severity of narrowing.
Why is rib cartilage used for nostril asymmetry correction?
Rib cartilage may be used when strong structural support is needed to rebuild the septum, reinforce the alar framework, support the nasal tip, or improve nostril balance.
Can breathing improve after nostril asymmetry correction?
Breathing may improve when nostril stenosis, internal nasal valve weakness, septal deviation, or airway collapse is corrected. The degree of improvement depends on tissue condition and healing.
International Consultation
For international patients, a photo-based consultation may help clarify whether nostril asymmetry correction rhinoplasty, nostril stenosis correction, rib cartilage reconstruction, Z-plasty, scar release, internal nasal valve support, or alar cartilage reconstruction may be needed.
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