11 November 2020 onur
“My nose looks different in my right and left view photos. Will this improve after surgery?”
“I am obsessed with symmetry. After surgery, my nose will be fully symmetrical, right?”
“My nostrils will be exactly equal in size, won’t they?”
I’m afraid the answer to all these questions is no.
Rarely, we can achieve symmetrical noses after surgery. Most of the time, it is impossible to achieve complete and perfect symmetry in the nose.
The basics first:
The human face is, without exception, asymmetrical.
It is congenitally asymmetrical, grows asymmetrically and ages asymmetrically.
When we evaluate the facial bones or internal structure of the nose with CT scans, we never see a symmetrical structure. Even noses that externally appear symmetrical are not completely symmetrical inside.
Bone structures and soft tissue masses surrounding the nose are not symmetrical. One side of the face is generally wider and/or protrudes more than the other.
We often do not notice these asymmetries in everyday life, but in the preoperative standardized photo examination, asymmetry on the face and nose can be easily seen and documented.
Even when you fit a perfectly symmetrical nose on an asymmetrical face, you will get different views from the right and left diagonal angles.
As a rule, if you start with an asymmetric nose structure in rhinoplasty, there will definitely be some asymmetry in the end. This statement may sound pessimistic, but it’s not that dire. In rhinoplasty, asymmetries in the nose improve often and significantly. What matters here is to know what is within normal limits and to set expectations according to the “normal” level.
A curvature of 0.5-1 degree is considered to be within normal limits in the human nose. In men, the tolerance to curvature in terms of aesthetic norms is greater than in women. The goal of rhinoplasty is to downscale nose curvature and asymmetry to normal physiological limits. If a curvature of 3-4 degrees before the operation can be reduced to less than 1 degree after the surgery, it is considered that the surgical goal has been reached.
Rhinoplasty may not reach even this normal level for some technical reasons.
- If there is damage or deficiency in the soft tissue of the nose,
- In the presence of congenital malformations (cleft palate, developmental disorders of the facial bones, etc.),
- In the presence of cartilage losses due to previous surgery,
- In the presence of septal perforation (hole) due to previous surgery,
- If the nasal bones are broken segmentally or at different levels in previous surgeries,
- In secondary cases where rib cartilage is used,
- In cases of asymmetry in the upper jawbone (maxilla),
- In cases of asymmetry in the bony frame (orbita) surrounding the eye,
- In the presence of facial paralysis,
- In the presence of previous high-energy traumas that cause comminuted fractures in the nasal bones,
It is almost impossible to achieve a completely symmetrical nose.
If surgeons have been able to obtain an “almost symmetrical” nose in such cases, they want to proudly show this case to anyone. This is an achievement worth boasting about. However, you should know that these examples are not a treatment standard.
If you adjust your expectation to a level of symmetry that can be achieved at a probability of 5%, you will be disappointed at a probability of 95%.
What’s more, even noses that are almost symmetrical during the operation or in the early postoperative period may be curved postoperatively in the long run due to reasons such as:
- Postoperative melting of cartilage,
- Bending of cartilage (warping),
- Loss of cartilage due to infection,
- Postoperative traumas,
- Scar contraction,
- and the aging process.
What’s more, in some cases, it is necessary to risk creating a weaker and more unstable nose structure just to obtain a more symmetrical nose. The “nasal septum” located in the midline of the nose may be curved in multiple axes and severely in some cases. You can’t straighten the nose without straightening the nasal septum. When curvature begins from the ethmoid bone behind the cartilage, the only way to straighten the nasal septum is to completely separate the cartilage from the bone. When you completely remove the cartilage from the bone, you need to take it out of the nose, shape it on the operating table, reinsert it in the nose and fix it firmly in its new location.
We call this procedure an extracorporeal (outside the body) septoplasty. Technically speaking, this procedure cannot be applied in every patient. In the eligible group, there is a risk of decreased nasal dorsal resistance and long-term collapse of the nasal ridge. The risk is low if the fixation is performed well, but it still needs to be considered.
What’s more, in some cases, noses that do not present a significant asymmetry or curvature preoperatively may become asymmetrical or curved postoperatively. Technically, rhinoplasty is a difficult surgical operation to learn and apply. Even rhinoplasty surgeons at the peak of their careers cannot perform every maneuver with perfect symmetry at every stage of every operation. Surgeon’s experience in rhinoplasty affects the success rate, especially in curved/asymmetrical noses. However, during the research phase, you will see that those who give the least guarantee to patients about rhinoplasty are often the most experienced surgeons.
So, what should you do if you had an operation and the asymmetry in your nose still bothers you?
In some cases, the remaining asymmetries in the nose following the first operation or those emerging due to the operation can be significantly corrected in secondary operations. If the asymmetry in the nose was ignored or overlooked in the first surgery, but there is no significant damage to the cartilage or bone structure of the nose, secondary surgeries have a good chance of success. If the first surgery has caused serious bone/cartilage damage in the nose and there is a lack of sufficient tissue, the chances of success are low. In cases where secondary surgery has a low chance of success, it may be more appropriate and safer to evaluate camouflage options such as fillers, fat injection, and crushed cartilage applications. Using 1 milliliter of filler and in a matter of only 10 minutes, it is sometimes possible to achieve results matching surgery. Camouflage options have their own risks and limits.
Please feel free to contact us for more detailed information on nose asymmetry and treatment alternatives.
Take good care…
… of yourself and your beauty.