Below is a before and after Nostril Asymmetry and Alar Snarl Correction Rhinoplasty to decrease how much the nostrils show from the front. Note all of these pictures on our website of patients' noses are based on Rhinoplasties that we have performed. Notice how the Asymmetric nostrils are corrected and the snarl appearance is also decreased. This person did not like how much her nostrils showed from the front and side. She said that it made her feel like she was angry or snarling at people. She felt that it gave her a negative look.
You can click here to see more Before and After Rhinoplasty Images
There are many ways to correct the Snarled Nostril and Asymmetric nostrils that come with it. 1. One way to do this is through some of the techniques of Rhinoplasty. Often times the cartilages that control the tip shape has something to do with it. Below you will see that the blue will illustrate the position of the tip alar cartilages that are positioned more vertically. This is defined by the rhinoplasty world as a cephalically positioned lower lateral cartilage. This structure supports the top of the nose but not as much as the bottom where the nostrils are located. Hence in this situation a Snarl would be more likely. Repositioning the lower lateral cartilages or specifically the lateral crus or leg of the lower lateral cartilages will allow the nostril to be more supported as shown in green.
Revision Rhinoplasty: Sometimes the snarl and the Asymmetric Nostril is due to rhinoplasty as in this case. In this situation, you are sometimes left with a lack of tissue. Below you will see some common ways for us to readjust the nostril rim. On the left, is a drawing in blue showing how adding tissue along the rim will help bring the rim down and cover and hide the nostrils from the front and the side. A composite graft is what Rhinoplasty surgeons call it. A composite graft is composed of skin and cartilage, whereas normal grafting usually consists of using one type of tissue being it bone, skin, muscle, fat, or cartilage. This most often is taken from the ear. The location that this is also more likely to be taken is in the concha cymbum shown in the image below.
Composite Graft: The green outlines where the composite graft is taken in the image above. This tissue of composite containing skin, cartilage together (drawn and measured to fit the area where the nostrils will most need lowering) is harvested and then sewn into the area that is shown in blue in the picture below on the left along the nostril rim. In this situation, the composite graft is used to make the nostrils more symmetric and to improve the snarl at the same time.
VY advancement: The picture above to the right illustrates another option. Instead of composite tissue, a VY advancement can bring more tissue to the rim area. A V is drawn and this is then advanced toward the nostril rim bringing more skin to the rim and away from the superior part of the nose. Sometimes you can add cartilage for more support at the rim area. This can effectively do what the composite graft can do. The V as it is drawn toward the nostril creates a Y as the tissue above is closed to create the straight line of the Y and the V is toward the nostril rim. Again a composite graft is a composition of skin and cartilage.
Alar Repositioning: Sometimes the nostril asymmetry is due to the alar base or the sides and base of the nostril being positioned in the undesired way. Repositioning the alar base is another option. The image below shows how you can advance the alar base toward the desired location. In this case, we advanced the alae inferiorly to help make the nostrils more symmetric. In the before picture, the patient did not like how the left nostril was higher than the right and wanted to see if we could lower it.
Tip Cartilage Asymmetry: There are other cases where the tip cartilages are asymmetric in their relation to each other which can be the cause of Asymmetric Nostrils. Rhinoplasty can help adjust how the tip cartilages are positioned in relation to each other. Below is an image of the lower lateral cartilages outlined in blue. During rhinoplasty, the lower lateral cartilages are positioned more symmmetric. Also any inherent deformities, missing cartilages are replaced and reshaped to make the tip cartilages more symmetric. This is another way of making the nostrils more symmetric.