The Effect of Nostril Retainer Use on Nostril Aperture Symmetry After Primary Aesthetic Rhinoplasty

Background and Objectives: Nostril aperture symmetry is an important component of nasal base aesthetics after rhinoplasty. However, nostril retainers are commonly used in reconstructive nasal surgery; their role after primary aesthetic rhinoplasty remains insufficiently defined. This study aimed to evaluate the effect of early postoperative nostril retainer use on nostril aperture symmetry after primary rhinoplasty using ImageJ-based morphometric measurements. Materials and Methods: This prospective, non-randomized comparative observational study included 52 patients who underwent primary open structural rhinoplasty. A total of 26 patients used a nostril retainer postoperatively, whereas 26 patients did not. Standardized basal-view photographs were obtained at postoperative week 1 and postoperative month 3. Right and left nostril aperture area, height, and width were measured using ImageJ software version 1.54 g after individual calibration with a millimetric ruler. Changes in symmetry indices from week 1 to month 3 were compared between groups. Results: Baseline week-1 symmetry indices were comparable between groups. The increase in area symmetry index from postoperative week 1 to month 3 was significantly greater in the nostril retainer group than in the control group (3.08 ± 4.99 vs. -1.00 ± 4.86; mean difference: 4.08; 95% CI: 1.34-6.82; p = 0.004). Changes in height symmetry index and width symmetry index did not differ significantly between groups. Conclusions: Early postoperative nostril retainer use was associated with improved nostril area symmetry after primary rhinoplasty. This benefit may be better reflected in global area-based symmetry than in isolated height or width measurements. Nostril retainers may represent a simple, noninvasive adjunct for selected patients at risk of early postoperative nostril asymmetry.