Many patients present to me in Beverly Hills with asymmetric noses. Being centrally located, it is the first feature noted after initial eye contact. And because of its prominent location in relation to the other facial features, asymmetries are easily recognized. These may be developmental or from previous trauma.
When we evaluate nasal symmetry, we first check to see the overall facial symmetry. Since the root of the nose starts between the eyebrows and the base of the nose ends over Cupid’s bow of the upper lip, it would be impossible to straighten a nose if the centers of these two landmarks were not directly in line. However, through differential cartilage grafting, we can give the illusion of a straighter nose. Next we evaluate the upper, middle and lower thirds of the nose. The upper third is generally bony and can be straightened via various fracturing techniques. The middle third is mostly cartilaginous and may require cartilage repositioning, resecting or grafting. And, finally, the lower third involves the cartilage and soft tissue of the nasal tip and nostrils— either of which can be asymmetric or unequal.
There are numerous techniques for addressing deformities of these nasal structures. The tip cartilages can be equalized and re-positioned, if necessary, and the nostrils can be made more equivalent through techniques that raise or lower the rims and narrow or expand the openings.