Denver Facial Plastic Surgeons

Indentation in Bottom of Nostril, Left After Rhinoplasty, Why is This? (photo)

I got a rhinoplasty a month ago and there is a huge indention in the nostril base on the left side. It makes my profile from the left look much worse than the right... Even if the doctor 'smooths it out,' how will this raise the indention? He almost gets offended when I ask about it. Has anyone ever seen this? I completely did not expect this. Trent

The indented area at the the base of the columella where it meets the nasal sil (nostril base) is most likely a 'relative' depression.  In other words, the columellar skin was dissected and remains significantly swollen at 1 month following rhinoplasty.  The nasal sil region was not dissected and did not suffer nearly the same degree of swelling.  Hence the columellar skin stands out further than the nostril base.  In time the contour should significantly improve.  If they are not still to your liking then a minor revision procedure will be necessary.

Mario Imola, MD, DDS, FRCSC.

Mario J. Imola, MD, DDS

Denver Facial Plastic Surgeon

I Have A Wide, Flat Nose. Can It Be Changed? (photo)

I have been very unhappy with my nose for several years now and have wanted rhinoplasty for about a year and a half. I don't want just a thinner nose, I want it to be completely different. Thinner and instead of being flat I would like it to have a point to it. With that being said, because my nose is so wide and big, is it going to be harder and more dangerous for me to get rhinoplasty? Will the recovery process take longer?

Your photos are very helpful.  Your analysis is accurate and I agree that your nose calls undue attention to itself and away from the rest of your beautiful facial features.  The changes you are asking for fall into the realm of ethinic rhinoplasty and reshaping is definitely possible . 

In general, African, Asian and Hispanic noses will have the following features when compared to a Caucasian nose:

• Increased width across the middle vault and nasal base.
• Decreased projection of the dorsum as well as the tip of the nose.
• Increased nostril flaring.

In most cases the ethnic nose is proportional to and 'fits' the rest of the face.  However, if reshaping is desired then ethnic rhinoplasty usually involves one or more maouevers:

• Dorsal augmentation grafting.  My preference is to use one's own tissues (autologous grafts) such as ear cartilage or rib grafts.  The technique I have gravitated to uses diced cartilage packed into a temporalis fascia cylinder.  This technique is excellent in that it is very well accepted when compared to synthetic implants and avoids the major pitfalls of solid cartilage grafts such as warping or graft edge visibility.
• Increased tip projection and definition. This can be accomplished using a combination of one or more of the following:  tip grafts, selective tip cartilage excsion and suture techniques.
• Alar base narrowing and nostril modification.  The width across the nostrils as well as nostril flare can be reduced using excision techniques.

I wish you the best of luck.

Mario J. Imola, MD, DDS, FRCSC.

Mario J. Imola, MD, DDS

Denver Facial Plastic Surgeon

Can an Old Nasal Fracture Be Rebroken by Pressure? How Can I Fix This Lump?

About five years ago I suffered a non displaced nasal fracture in the lower third of the nasal bone. Last year I became almost obsessed with the cosmetic affect of my injury. Anyhow, I continually pushed my nasal bone thinking that i could move the bone, and now there seems to be a lump, or spur, on my nose. Is this just swelling? Or could I have moved bone, in which surgery is the only possibility to correct the cosmetic issue??

Following a nasal fracture, the bones are fairly well healed by 8 to 12 weeks.  Any movement of the nasal bones would be impossible without re-fracturing them.  In fact, by 3 to 4 weeks it is difficult to move the nasal bones without substantial force.  Any reshaping of the nose at this point will require surgical correction. 

Mario J. Imola, MD, DDS

Denver Facial Plastic Surgeon