Nostril Asymmetry and Stenosis Correction – A Complex Reconstructive Surgery Case

[Nose Lab Clinic]

Hello, this is Dr. Cha-Young Kang, Director of Nose Lab Clinic.

Today, I’ll introduce a challenging nostril asymmetry and stenosis correction case, which resulted from multiple previous surgeries, nasal base reduction, and philtrum reduction.

This patient had undergone repeated surgeries and inflammatory reactions, which led to nostril asymmetry, collapsed alar cartilages, and airway obstruction.

1. Patient’s Condition – Structural & Functional Issues

Design Consultation: Frontal View, Left Side View, and Oblique Side View Photos

Preoperative Analysis

✔ Significant nostril asymmetry (visible from the front view)

✔ Wide and uneven nasal shape

✔ Pinched, constricted nasal tip

✔ Right-sided nostril stenosis

Design Consultation: Right Side View, Oblique Side View, and Nostril View Photos

Patient’s Requests

✔ Correct nostril asymmetry

✔ Improve right nostril stenosis

✔ Maintain nasal bridge height (no reduction or significant height increase)

✔ Avoid lengthening the nose

2. Surgical Plan – Customized Nostril Asymmetry and Stenosis Correction

✅ Step 1:  Structural Reinforcement

🔹 Reconstruct the septum using autologous rib cartilage

🔹 EExtend the nasal septum to improve nostril symmetry

✅ Step 2: Functional Correction

🔹 Perform Z-plasty to release right nostril stenosis

🔹 Reconstruct collapsed alar cartilages using rib cartilage and dermal grafting

✅ Step 3: Aesthetic Refinement

🔹 Augment a depressed nasal dorsum with rib cartilage

🔹 Reduce a wide nasal bridge with lateral osteotomy

3. Surgical Execution & Key Adjustments

a. Structural Rebuilding

✔ Autologous rib cartilage grafting was performed to rebuild a stable septal foundation.

✔ Cartilage extension was used to restore nostril balance.

b. Functional Improvements

✔ Z-plasty was performed on the right nostril to correct stenosis and improve airflow.

✔ Scar tissue removal and nasal valve support were reinforced.

c. Aesthetic Refinements

✔ Soft tissue support was restored using dermal grafting to correct a pinched nasal tip.

✔ Depressed areas of the nasal bridge were elevated for a smoother, natural profile.

✔ Lateral osteotomy was performed to refine the wide nasal bridge.

4. Post-Surgical Outcomes

Before (Left) / Immediately After (Right)

Frontal View

✔ More balanced nostrils – no longer asymmetric

✔ Corrected pinched nasal tip

✔ Straighter and refined nasal structure

Before (Left) / Immediately After (Right)

Side Profile

✔ Improved nasolabial angle (natural, non-overcorrected position)

✔ Smooth and proportional nasal tip projection

✔ Corrected depressions and asymmetry

Before (Left) / Immediately After (Right)

Nostril Functionality

✔ Right nostril stenosis successfully corrected

✔ Scar contracture improved with Z-plasty

✔ Restored alar support prevents collapse

Before (Left) / Immediately After (Right)

5. Expert Insights – Challenges of Nostril Asymmetry and Stenosis Correction

Risks of Overdone Nostril Reduction (Alarplasty) & Philtrum Shortening

1️⃣ Excessive nostril reduction can lead to permanent airway obstruction.

2️⃣ Nostril asymmetry is common if too much tissue is removed.

3️⃣ Correcting these issues requires complex reconstruction, often with rib cartilage or skin grafting.

Lessons from This Case

✅ Nostril narrowing procedures should always be performed conservatively.

✅ Reconstructive options exist, but complete reversal is difficult.

✅ Patients should consult a highly experienced specialist before undergoing nostril or philtrum reduction surgery.

6. Final Thoughts & Patient Advice

Immediately After Surgery: Frontal, Side, and Oblique Side View Photos

Immediately After Surgery: Nostril View Photos

Key Takeaways for Those Considering Nostril Reduction Surgery

✔ Minimal reduction is best to avoid functional complications.

✔ Consider long-term effects before opting for aggressive alarplasty or philtrum shortening.

✔ If breathing issues arise post-surgery, seek early correction before scar contracture worsens.

Why Choose Nose Lab Clinic?

✔ Precision-driven surgical techniques

✔ Balance of function and aesthetics

✔ Specialized in complex reconstructive rhinoplasty

This case highlights the importance of careful surgical planning when correcting nostril asymmetry, stenosis, and nasal collapse.

At Nose Lab Clinic, all surgeries are performed using a closed (endonasal) approach.

Postoperative precautions and possible complications after rhinoplasty

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