Almost everyone has one nostril larger than the other. If you have just noticed yours, you have not developed a problem. You have started looking at the base of your nose properly for the first time, probably in a photograph taken from below, which is the least flattering angle there is.
Faces are not symmetrical. One eye sits slightly higher, one side of the jaw is slightly fuller, and the nose, sitting in the middle of all of it, reflects that. Perfect nostril symmetry is rare enough that when I see it I notice.
So the question worth asking is not "are my nostrils asymmetrical?" It is "is my asymmetry telling me something?"
When is one nostril bigger than the other just normal?
If both nostrils breathe equally well, the difference is subtle, and it has been there as long as you can remember, that is normal variation and there is nothing to investigate. It becomes visible mainly in base-view photographs and in harsh overhead lighting, neither of which is how anyone sees you.
It is worth saying plainly: nobody else notices. People view your face from the front and in three-quarter view, not from below. The asymmetry you have been studying in your phone camera is, in ordinary life, invisible.
When does nostril asymmetry mean something?
Three patterns are worth taking seriously.
One nostril is smaller and that side is blocked. This is the useful one. The front and lowest part of the septum, called the caudal septum, sits between the nostrils and forms part of their shape. If it deviates to one side, it narrows that nostril and obstructs it at the same time. So the asymmetry and the blockage share a single cause, and correcting it addresses both.
Caudal septal deviation is also the type most likely to be visible from outside, because that part of the septum is right at the entrance of the nose, and it can push the whole tip off centre.
The asymmetry appeared or changed. New asymmetry in an adult means something changed: an injury, a septal haematoma, collapse of the sidewall, or a mass. That needs looking at rather than living with.
It followed previous nose surgery. Nostril asymmetry after rhinoplasty is one of the more common reasons patients seek revision rhinoplasty. It can result from unequal cartilage resection, asymmetric healing and scar contracture, or collapse of one side. It should be assessed properly rather than dismissed as swelling once a year has passed.
Can a deviated septum cause uneven nostrils?
Yes, but only a deviation in one particular place. The nasal septum is the wall of cartilage and bone dividing the inside of the nose into two passages. A deviated nasal septum simply means that wall is off centre, which is true of most people to some degree.
What decides whether it shows in your nostrils is where the deviation sits. Further back, it narrows the airway and makes breathing harder without changing anything you can see from outside. At the very front, in the caudal septum, it changes the nostril as well. So a deviated septum can make one nostril smaller. Plenty of them never do.
That difference decides the operation. It is the first thing I try to establish, because the surgical answer for a caudal deviation and the answer for a deviation further back are not the same. There is more on the deeper septum in deviated septum symptoms, surgery and recovery.
What else causes asymmetrical nostrils?
Asymmetric lower lateral cartilages. The paired cartilages forming the nostril rims and tip are frequently unequal in size, shape or position. Purely developmental.
Nasal valve collapse, where the sidewall is too weak to hold its shape. That nostril looks narrower, and narrows further when you breathe in. Common after previous surgery and in noses with naturally thin cartilage. More on nasal valve collapse.
Differences in skin and soft tissue thickness, which change how a nostril appears without any difference in the cartilage underneath. Thick skin hides small differences. Thin skin makes every one of them noticeable.
Old trauma, including injuries in childhood that nobody treated.
Facial asymmetry, where the underlying bone platform is uneven, so the nose sits on an asymmetric base. An asymmetrical nose is sometimes a perfectly formed nose resting on an uneven foundation, and no amount of work on the nose itself will change the foundation.
Cleft lip, where nostril asymmetry is characteristic and part of a broader reconstructive picture.
Habitual sleeping position or resting your face on a hand, which is often blamed and is not a real cause.
Symptoms worth mentioning at your appointment
Uneven nostrils on their own tell me very little. What they mean depends on what else is going on, so if any of these apply, say so:
- Blockage that is clearly worse on one side, or that swaps sides through the day
- Nosebleeds, particularly from the same nostril each time
- Snoring or noisy breathing at night, and disturbed sleep
- Facial pain or pressure, or repeated sinus infections
- A reduced sense of smell
- Sprays and antihistamines that help a bit but never quite enough
A patient with uneven nostrils and none of this has a cosmetic question. A patient with uneven nostrils and half of that list has a structural one, and the two lead to very different conversations.
How I work out which it is
Examination comes first. I look at the nose from the front, from the side and from below, because the base view is the only one that shows the nostrils properly, and I take standardised medical photographs so we are both looking at the same images rather than at your phone camera in bad light.
Then I look inside using an endoscope, a thin telescope that shows the septum along its whole length and the turbinates behind it. That is what tells me whether the deviation is at the front, where it shapes the nostril, or further back, where it only affects airflow.
I also ask you to breathe in hard while I watch. A sidewall that only pulls inwards on a strong sniff looks entirely normal at rest, and missing it means treating the wrong problem.
Scans are rarely needed for this. A CT scan answers questions about the sinuses, not about nostril shape.
Can uneven nostrils be fixed without surgery?
No spray, tablet or drop changes the shape of a nostril. Medical treatment works on the lining. The framework underneath is a surgical problem. That said, a steroid spray or an antihistamine can settle swollen lining and open up a blocked side, which genuinely helps if allergy is part of why the narrow side feels so tight. It is worth a proper trial before anyone discusses surgery. It will not make your nostrils match.
One warning, based on how often I see it. Decongestant sprays work brilliantly for a few days and then stop working, and using them beyond about a week causes rebound congestion, called rhinitis medicamentosa, which leaves the nose more blocked than it started.
How can asymmetrical nostrils be corrected?
The honest starting point: nostril asymmetry can be improved. It cannot be perfected. Anybody promising you identical nostrils is promising something surgery does not reliably deliver, because healing is not symmetrical either.
If the cause is a deviated caudal septum, correcting it is the most rewarding option, because it improves your breathing and your appearance from a single operation. This is more demanding than a standard septoplasty, since the caudal septum is structurally important and cannot simply be trimmed away without losing tip support. It usually requires repositioning and grafting rather than removal.
If the nostrils themselves are unequal in size or flare, alar base surgery adjusts them, with small incisions hidden in the natural crease where the nostril meets the cheek. Precise, effective for width and flare, and it leaves a fine scar that is generally very well concealed.
If the tip is twisted or the rims sit at different heights, tip work is needed: suture techniques, rim grafts, or repositioning the lower lateral cartilages. This is the most technically demanding of the three and the least predictable, because it is fighting the scar contracture that follows.
If the whole nose is deviated, the nostrils will not be straightened by working on them alone, and a septorhinoplasty addressing the whole framework is the right operation.
In many cases these are combined: correcting the caudal septum and reshaping the nasal tip in one operation, with a small alar base adjustment at the end if the nostrils are still unequal in size. Which of them I recommend depends on what the examination shows, not on what looks wrong in a photograph.
What is recovery like after surgery for uneven nostrils?
It depends on how much was done. Alar base surgery on its own is the lightest of these procedures. The sutures at the nostril crease come out at about a week, bruising is minimal, and most people are comfortable being seen in public within a few days.
If the caudal septum or the tip has been corrected, or a full septorhinoplasty performed, recovery follows the pattern of any rhinoplasty. A small external splint stays on for about a week, the nose feels congested for the first couple of weeks, and most people return to desk work at one to two weeks. Strenuous exercise waits around three to four weeks, and contact sport, or anything else with a real risk of a knock to the nose, waits longer. There is a fuller week-by-week account on my recovery page.
The part patients find hardest is not the splint or the congestion. It is the wait for symmetry, which brings me to timescales.
What will the result look like, and when?
Swelling does not run to a schedule you can rush. The alar base settles within a couple of months, but the nasal tip is the last part of any nose to finish, and the final shape is not there until a year or more, due to the slow resolution of deep swelling and scar contracture. In patients with thicker skin it takes longer still. Judging your symmetry at six weeks will make you miserable and tell you nothing useful.
The realistic outcome is better overall balance, with nostrils that look even in normal light and in ordinary photographs, and still show a small difference if you go looking for it in a base view. That is a good result. Chasing the last of it is how surgeons make noses worse.
How much does it cost to fix uneven nostrils?
Alar base surgery starts from £4,500, tip surgery from £8,000, and septorhinoplasty from £10,500. Correcting a caudal septal deviation is normally part of one of those rather than a standalone procedure. Where the aim is the airway rather than the appearance, functional septoplasty starts from £6,000. Consultation is £250, credited towards surgery if you go ahead, and you get a written quotation before committing to anything. Full detail on my pricing page.
The honest advice
If your nostrils are slightly different and you breathe fine, do nothing. This is normal anatomy, it is not visible to anyone but you, and surgery to correct it carries a genuine risk of trading a small asymmetry you have noticed for a different one you have not.
If one nostril is smaller and blocked, that is worth investigating, because there is likely a caudal septal deviation underneath and treating it improves both problems at once.
If it changed recently, or followed surgery, get it examined.
Frequently asked questions
Is it normal to have one nostril bigger than the other?
Yes, and it is close to universal. Faces are not symmetrical, and the nose sits in the middle of one. If the difference is long-standing and both sides breathe well, it is normal anatomy rather than a problem.
Why is one of my nostrils smaller?
Most often a deviation of the caudal septum, the front and lowest part of the dividing wall, or naturally unequal tip cartilages. Nasal valve weakness and differences in skin thickness between the two sides can also play a part.
Can asymmetrical nostrils be fixed?
Improved, yes, through caudal septal correction, alar base surgery or tip work, alone or combined. Perfect symmetry is not a realistic goal, because healing is not symmetrical either. The right operation depends on the cause, which is what the examination establishes.
Does a deviated septum always cause uneven nostrils?
No. Most deviations sit too far back to change the nostrils and only cause breathing problems. It is the front part, the caudal septum, that shapes the nostril, so that is the one to look for.
How do I know if uneven nostrils are more than a cosmetic issue?
One-sided blockage above all. Add nosebleeds from that side, snoring, facial pressure or repeated sinus infections and the case for a proper assessment gets stronger.
Can nasal valve collapse make one nostril look smaller?
Yes, and the giveaway is that it looks worse when you breathe in hard. A weak sidewall pulls inwards with airflow. It is one of the causes worth ruling out in a nose that has been operated on before.
Will a septoplasty make my nostrils even?
Standard septoplasty addresses the deeper septum and usually will not change nostril shape. Correction of the caudal septum can, because that part of the septum sits at the nostril entrance and helps form its shape.
Is nostril asymmetry after rhinoplasty normal?
Some asymmetry during the first year is expected while swelling settles unevenly. Persistent asymmetry beyond a year deserves proper assessment rather than reassurance that it is still swelling.
Can fillers correct uneven nostrils?
Not meaningfully. Fillers add volume, and they cannot reposition cartilage or reduce the size of a nostril. Where the cause is structural, the answer is structural.
Does breathing through one nostril more cause it?
No. The nasal cycle alternates airflow between the two sides in everyone, all day, and it does not change nostril shape. Habitual sleeping position does not cause it either.
If one nostril is both smaller and blocked, that combination usually has a single cause and it is worth having examined. You can book a consultation, and if I think your asymmetry is normal variation best left alone, I will tell you that.
Mr David Whitehead is a Consultant ENT and Facial Plastic Surgeon in London, on the GMC Specialist Register for Otolaryngology and certified by the Royal College of Surgeons Intercollegiate Board in Cosmetic Surgery. More about my training and credentials.