APS Aesthetic Plastic Surgery · 2025

Exploring Nasal Wall Cartilage Asymmetry in Rhinoplasty: Implications for Postoperative Symmetry

Hafezi F, Sahafi SM, Nadjafi Semnani F.

PubMed 39455456 Publisher (DOI)Free full text (PMC)

What this paper says

Measuring cartilage removed from 60 rhinoplasty patients, the lower tip cartilage was significantly thicker on the left than the right, while the upper cartilage showed no difference.

Overview

Facial symmetry is associated with attractiveness, though minor asymmetries are normal and human asymmetry tends to favor the left side. Whether the cartilage of the nose differs in thickness between sides had not been studied. The authors measured strips of upper and lower lateral cartilage excised during routine surgery from 60 patients undergoing primary open rhinoplasty.

Sections of note

Design: cross sectional study, 60 patients undergoing primary open rhinoplasty. Level of evidence IV.
Four tissue samples were taken per patient: upper and lower lateral cartilage strips from each side.
Thickness and width were measured using a microscope stage calibration slide.
43 patients were female, 72 percent, and 17 male, 28 percent.
Upper lateral cartilage: mean thickness 0.53 millimetres on the right and 0.54 on the left, p equal to 0.52, not significant.
Lower lateral cartilage: mean thickness 0.50 millimetres on the right and 0.54 on the left, p less than 0.001, a significant left sided difference.
The left sided dominance was consistent across both sexes.

What it means for a patient

The tip cartilages differ in thickness between sides by about 0.04 millimetres, with the left consistently thicker.
Cartilage that differs in thickness responds differently to the same suture or trim, which is one route to asymmetry after surgery.
The measured difference is very small in absolute terms, and the abstract does not show that it produces visible asymmetry.
Limits: 60 patients, single centre, measurement of excised strips rather than the whole cartilage, and no link to postoperative outcomes.

Why this paper matters

Nostril and tip asymmetry after rhinoplasty is common and usually attributed to technique or healing. Documenting an underlying difference in the tissue itself offers another explanation. Whether accounting for it during surgery produces more symmetric results is not tested.

Terms

Upper lateral cartilage: the paired cartilages forming the middle third of the nose.
Lower lateral cartilage: the paired cartilages forming the nasal tip and nostril rims.
Primary open rhinoplasty: a first nose operation using an external columellar incision.
Cross-sectional study: a study measuring a group at one point in time.
Stage calibration slide: a precisely marked slide used to measure objects under a microscope.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Introduction: Facial symmetry is prized for its association with health, genetic quality, and attractiveness, but minor asymmetries are common. Human asymmetry tends to favor the left side and is noticeable in various nose parts. However, the discrepancy in cartilage thickness between the nose's right and left sides remains understudied.

Method: This cross-sectional study involved 60 patients undergoing primary open rhinoplasty. During routine rhinoplasty Procedure, upper and lower lateral cartilage strips were excised from each patient, yielding four tissue samples. Tissue thickness and width were measured using a microscope stage calibration slide. This approach systematically assessed left and right cartilage thickness differences in primary open rhinoplasty patients, offering insights into nasal asymmetry and potential surgical implications.

Results: Out of 60 patients, 43 were female (72%) and 17 were male (28%). The mean thickness of upper lateral (UL) cartilage was 0.53 mm on the right and 0.54 mm on the left side (P value= 0.52). For lower lateral (LL) cartilage, the mean thickness was 0.50 mm on the right and 0.54 mm on the left side (P value < 0.001), indicating significant left-sided dominance. This dominance was consistent across both sexes.

Conclusion: Our study highlights the significance of addressing subtle nasal cartilage asymmetries to improve postoperative symmetry. Modifying nasal cartilage microstructures during rhinoplasty can enhance both aesthetic and functional outcomes.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).