Revision Rhinoplasty: Q&A
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How to Decrease Indentation and High Nostril Crease After 1st Rhinoplasty
I had rhinoplast one year ago. It looks like I have a pinched tip. The supra alar crease is extremely deep and pronouned, running far up the nose. How can this be fixed? The doctor who did the surgery said that grafts inside the nose will make my nose bigger. I am seeking a permanent result to fix it. What are the options?
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10 Doctor Answers |
Asked by
suay
in Australia
+2
Correction of pinching
This feature can be improved with grafting of the lateral nasal walls - there may be enough cartilage in your septum, if not, a rib graft may be needed
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Reducing alar crease indentation
There are multiple tip techniques to reduce alar crease indentation, which involves on-lay grafts, alar rim grafts, and an alar batten grafts. It really depends on what the issues are and how much cartilage is left inside the nose. A cartilage-depleted nose due to previous surgery will be difficult to repair these types of problems of alar pinching. Asymmetries are best addressed by trimming some of the columellar membranes and caudal septum.
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Consider Filling Injections
Hi, Suay.
Have any local surgeons suggested trying a filling injection? It would be a low-risk solution.
My colleagues are correct in stating that if you have a breathing problem surgery is needed. However, if the matter is one of appearance, check out the possibility of plumping that somewhat pinched area witha filler.
-Robert Kotler, MD, FACS
Beverly Hills, CA
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Correcting a pinched tip in revision rhinoplasty
The most common cause of a pinched tip (what some patients call a "sausage nose") after rhinoplasty is contraction of the skin and soft-tissue envelope of the nose without adequate support of the lower lateral cartilages. In your case, it appears that perhaps the lateral crura of these tip cartilages were too weak or flimsy to support this contraction process. This issue can be corrected in revision rhinoplasty by placing lateral crural strut grafts. These grafts are...
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Deep creases in the nose are treated with cartilage grafts
In both primary and revision rhinoplasty, deep nostril, or alar, creases are treated by using grafts of your own cartilage to support the indented tissue. This will make the nose appear a little fuller but it will also look more natural. Deep creases makes the tip of the nose look like it is separate from the nostrils. Deep creases can also mean that the nostril cartilage is collapsed and may block breathing as well. Restoring the contour makes a more natural appearing nose. To...
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Correcting alar depressions
If you are having breathing issues as well as the pinching, it would probably be best to correct those areas with a sturdy cartilage graft to prevent further collapse. Smaller areas can be corrected with fillers or crushed cartilage if support is not needed. You need to see a rhinoplasty expert in your area to better address this problem.
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Your deep supra-alar creases may be improved by a well-performed Non-Surgical Rhinoplasty.
I read your concern and reviewed the photo of your nose.
I have had wonderful success filling deep supra-alar creases with Silikon-1000 as an off-label, permanent injectable filler. In my practice, Silikon-1000 is also used to lower the height of your nostrils with permanent results.
I attached a photo from my RealSelf gallery demonstrating correction of supra-alar creases after previous rhinoplasty surgery.
I hope this is helpful for you.
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Decreae Indentation and High Nostril Crease
Hi,
The only way to improve the crease would be to use a cartilage graft. The cartilage graft may be very small but could make a big difference.
Best of Luck,
Dr.S.
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Pinched tip
If you are complaining about a pinched tip, yes, then cartilage grafts may be the best thing to use to improve that problem.
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Rhinoplasty
It seems that this type of overresection of the lower lateral cartilage is common in Thailand.
You had over resection of the lateral portion of the lower lateral cartilage
The tip is still not refined.
You need a alar cartilage graft and refinement of the tip. retracted ala is caused by over resection of the lateral part of the lower lateral cartilage.
Consult a BOARD CERTIFIED PLASTIC SURGEON FOR PROPER DIAGNOSIS AND TREATMENT RECOMMENDATION
Baltimore Plastic Surgeon
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