I am looking for the right doctor to help me with a revision. I do not like the doctors in my area (las vegas) and I am willing to fly out of state. I want my nose less wide, less droopy, no knuckling or "stuck on nostrils" and most of all I want symmetry. I a m 4 years post op. Currently saving my money now because I know I want this done. I am also interested in getting a bullhorn lip lift to make my lips symmetrical and balance the width of my lips. I want to get it right this time.Are My Expectations Reasonable? What is the Typical Cost?
What Would You Do to Me for a Revision Rhinoplasty? (photo)
Doctor Answers (9)
A revision is in order in your case, there are several issues that need to be addressed. I can not see your entire mouth to advise on the bullhorn lip lift. I strongly suggest that you consult with a Board Certified Facial Plastic Surgeon. I am a leading expert on this type of revision. Please feel free to contact my office and schedule a consultation with me if you are thinking about having your procedures done in the Beverly Hills area.
Rhinoplasty and Lip Lift
You have reasonable expectations. The nasal tip looks like it has been altered but has lost its balance. This is primarily caused by alteration to the lower lateral cartilages. I think the tip could be improved. From the basal view (looking up your nostrils), your right nostril looks weaker and slightly collapsed when compared to the left and the inner part of your right nostril (medial crura) is wider, making your right nostril smaller than the left.
A bullhorn lip lift will also shorten the length between the upper lip and the bottom of your nose. This is a common request in our office that is successfully addressed.
Please consult with a board certified specialist who can best assist you in achieving the results you seek.
The problem I see is not so much an increase in the width of the tip, but one of proper proportions. By comparing the preop and postop views, it looks as though an attempt was made at narrowing the tip. If you look closely, the lower portion of the tip is narrower. The width that you describe is above that and looks worse now that the inferior tip is narrower. You have a common deformity in which the cartilage of your lower 1/3 of your nose is angled too high. This creates deep sidewall depressions and gives you that "stuck on nostril" appearance. This transition zone needs to be augmented with cartilage to smooth out that transition zone.
Other techniques are available to make you nose more triangular in nature (ideally an equilateral triangle on base view). If you look at your base view postop, your nasal tip has a tent pole type appearance with concavities of the nostrils on both sides instead of the desired straight or slightly concave appearance. Lastly, one of the pictures indicates that you may have some columellar excess or a hanging columella. This can be addressed as well. The typical cost of revision in my practice is about $8000.
Michael Kim, MD
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You do have a collapse of your tip with asymmetrical nostrils and increased width of your tip. With the appearance of your nose I suspect you also have breathing problems. Over 2/3rds of the nose I do are revisions and the asymmetry you describe is a common complaint. A profile view should also be evaluated. Your expectations are reasonable; it will cost $8,000-10,000 depending on what is necessary.
Revision rhinoplasty recommendation
To address a wide nose osteotomies are performed. To address wide nostrils an alarplasty is performed. The droopiness can be eliminated by releasing the depressor septi ligament, tucking in the columellar show, and raising the tip slightly. Symmetry is of importance in rhinoplasty. The typical cost for revision rhinoplasty is approximately $9000, which includes the operating room, anesthesia, and surgeon’s fee for performing the procedure.
Revision rhinoplasty to improve nose
Revision rhinoplasty could be used to improve your nasal appearance and make it appear more natural. Your tip can be improved by addressing the malposition of your tip cartilages (see link of a blog post below that discusses this). After your initial surgery your lower lateral crural cartilages healed pointed in a more upward direction (cephalic positioning). This leads to an isolated-appearing tip that doesn't transition normally to the nostrils.
The width of your nostrils can also be addressed at the same if you like. Seeing a profile view would allow for a better sense if anything needs to be addressed from that angle. It sounds like it is more down turned that you'd like. It should be possible to elevate the tip if this is the case. Your base view does show suggest a deviation of your septum that is causing your right nostril to be smaller than your left. This can also be addressed.
A bulhorn lip lift can also be considered. This is a pretty common way to shorten the upper lip length and also improve the amount of upper red lip show.
Revision rhinoplasty and lip lift
A revision rhinoplasty could certainly address your concerns. I would agree that your nose (and nostrils) appear asymmetric, the tip is misshapen and your columella appears to be hanging low which may cause your concerns of a "droopy tip" in the front view. Without a profile view it is difficult to comment on the actual height of your tip and your overall nasal contour. A lip lift can be combined with a revision rhinoplasty and it often results in pleasing results as long as you have a long upper lip in proportion to your remaining facial features.
What Would You Do to Me for a Revision Rhinoplasty?
Aestheically speaking, the nose could be a bit thinner along the nasal bones and there appears to be evidence of an "open roof" deformity from a previous nasal hump removal. If this is the case, the nasal bones would need to be broken towards the midline in order to close the open roof which would also narrow the nose. The tip appears to be wide, and there's the telltale appearance of spreader grafts that increase the width and volume of the nasal tip which is often not aesthetically attractive. This area would be thinned by removing excess scar tissue and spreader grafts if present. The tip does appear droopy and should be strengthen and/or be rotated upward.
The lips should have an ideal aesthetic proportion which yours do not have...the upper lip should have a larger volume to balance out the lips. Alloderm Lip Implants are the best for this purpose and I would use this in your upper lip only (your lower lip is ideally shaped already).
As you will quickly discover, Revision Rhinoplasty costs are all over the map as are the recommendations of how to make your nose more attractive. Be sure that the plastic and cosmetic surgeon, you select, understands and follows the proper aesthetics of facial (and nasal) beauty for the creation of a naturally more attractive nose and face.
Revise your nose..I'm an expert to correct pinched tip
Your nose does indeed look" nosejobby". Two of the things you need to have repaired are things I am considered a world expert in. First you have a pinched tip. This occurs from a poor surgical technique and is defined as a groove,( like you described.) which indents your nostril rim as if you were pinching it together with your fingers. I presented a lecture to the Rhinoplasty Society in a simple technique I have used in satisfactorily correcting over 100 pinched tip patients. It was well received and many doctors are now using it in their practice. The second thing is a plunging tip where your nose points down when smiling which I can also repair. There are many less important facets which need to be matched to the new tip but I can show you that on the computer. I would be honored if you chose me to repair it. By the way I just won first inTop Ten in America for best plastic surgeon in Los Angeles and best facial surgical correction at the Aesthetic Academy. Again I'd be honored if you chose me to correct it. I am in Beverly Hills just an hour flight from you.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.