How to fix asymmetric or uneven nostril sizes
Many people wonder what causes asymmetric nostril sizes. This issue can occur either naturally or secondary to prior nasal surgery or trauma. The typical cause is a deviation of the caudal septum. The caudal septum is the portion of the septum (dividing wall of the nose) closest to the nostril openings. It normally lays in the mid-line of the nose and sits behind the columella. The columella is the bridge of tissue that separates the nostrils themselves.
Treatment of caudal septal deviation
Rebuilding of the caudal septal deviation is often the first step in correcting asymmetries of the nostril openings. This can involve either repositioning the existing septum or removing the deviated portion of cartilage and reconstructing it with a new, straight piece of cartilage (typically taken from a different part of the septum). Once the caudal septum is placed in the midline the columella can then be secured to the septum using sutures. This ensures a stable columellar/tip complex and long lasting improvement to the nostril asymmetry.
Flared Medial Crura
Another cause of nostril asymmetry is asymmetric positioning of the medial crura. These cartilage that make up the columella normally flare toward the floor of the nose. Sometimes this can occur asymmetrically such that correction can be achieved by repositioning these crura.