Had rhinoplasty 1 yr & 3 mths ago, & a small in-office revision to lift the tip a bit. After viewing my pics, am I a good candidate for revision and if so, what can be done? My PS says the risks of scarring outweigh the chance of getting a better result. I am looking for another opinion. I do not like the asymmetry of my nostrils, the left side seems flared, and the tip seems too big. I worry I also have scar tissue. Could you help me define the problem and suggest possible solutions? Thank you!!
What Will Be Involved in my Rhinoplasty Revision? Are my Problems Fixable? (photo)
Doctor Answers 11
What Will Be Involved in my Rhinoplasty Revision? Are my Problems Fixable?
Aesthetically speaking the nasal tip is asymmetric, the columella is crooked and the nasal tip is under-rotated. An open Revision Rhinoplasty or rather a Tip-plasty with a conchal cartilage ear graft to strengthen and refine the nasal tip would be advised. Hope this helps.
"Am I a candidate for revision rhinoplasty?"
While your dorsum looks good, your tip is definitely asymmetric. It is tilted to the left side, the tip cartilages are positioned in an uneven fashion causing asymmetry at the dome area and columella. On the profile view, your tip would benefit from more rotation which would improve the nasolabial angle and make the nose appear slightly shorter. part of the problem may be that your septum is still deviated to the right side contributing to the tip asymmetry. To sum it up, you would benefit from the revision rhinoplasty (mainly tip-plasty and possibly septal surgery) and I think you should definitely consider one.
Revision rhinoplasty can be done
There certainly are some cosmetic irregularities to your nose that can be addressed. It is somewhat hard to give complete answers based on your photos, but your nostril are asymmetric and your septum deviates to the right. A review of your prior operative report can tell which, if any grafts were used and thus can be used to give you a better cosmetic result.
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Is Improvement a Reasonable Expectation with Revision Rhinoplasty
In the hands of a revision rhinoplasty specialist the deviation of your septum and the asymmetry of your tip cartilages can be corrected. Go to my website for instructions on how to take pictures for nasal evaluation so we can make a complete visual analysis of your appearance. I see many patients with similar problems after their original surgery and encourage you to consider a revision.
Your posted photos do not allow full assessment of the bridge. The frontal photo is cut off below eye pupil level so the degree or type of septal deviation is not clear. The issues with the tip though are clear in your posted photos. It appears that your previous rhinoplasty was an open one as there is a stair step scar on the strip of skin between the nostrils (columella). The tip is currently asymmetric with the left tip cartilage kinked at the upper inner edge of the left nostril and rotated counterclockwise relative to the right tip cartilage. The kink is so severe that it is blanching the skin. The right tip cartilage is rotated clockwise so you can see the bottom of it pushing into the right nostril. The tip is also rotated slightly downward and projects forward more than 2/3 of the length of the bridge.
You most definitively need a revision and sufficient time has passed from your past surgery for it to be done safely. I do not think the risk of scarring outweighs the possible benefits of a revision surgery as long as you choose your revision surgeon carefully. If your current surgeon is unwilling or unable you will need to find another surgeon though revisions are usually best done by the original surgeon. You need to get copies of your operative reports from the previous nasal surgeries so that any prospective surgeons you see can use them to plan the revision.
What needs to be done to correct the situation depends on what was done at your last surgery. If the inner leg of both tip cartilages were shortened and sutured but the suture pulled through or the cartilage edges slipped the solution could be as simple as replacing those sutures and placing a small strut of cartilage between them to prevent the edges from slipping again. That would unrotate the tip cartilages and realign them more symmetrically. If the original shortening was insufficient more cartilage will need to be trimmed first. Sutures between the tip cartilages and the septum could then be used to rotate the tip slightly upward. The approach is probably best done as an open rhinoplasty with extra care to avoid cutting into the cartilage kink on the left.
Some septum or bridge adjustment may be required but that cannot be assessed from your posted photos alone.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
Yes, after a year your tissues should be soft enough to be able to undergo a revision to correct your nostril asymmetry and correct your caudal septal deflection. Good luck.
Revision Rhinoplasty Required
At 1 year and 3 months, you are in the clear for a corrective MULTIFACETED procedure of a delicate nature. So it is important that you choose a board certified surgeon of extensive experience to have the best shot obtaining optimal results.
You certainly can benefit from an adjustment targeting your septal deviation and your nostrils asymmetry. Also, you will need to have your overprojected tip reduced.
Thank you for your inquiry and sharing your photos.
Best of luck to you.
Revision rhinoplasty needs
There are several things that can be done to improve your result. You appear to have a caudal septal deviation making your nostril asymmetric and columella shifted. This can be straightened. You tip is very overprotected relative to the length of your upper lip. This can be set back which will give you a sense of "reduction". You will need alar reduction as well to accommodate the set back. While there is always risk of scarring with revision rhinoplasty, all these maneuvers are relatively routine to a surgeon experienced in and comfortable with revision rhinoplasty. Finding one needs to be your next task in order to move forward.
The most important thing you should consider regarding a revision rhinoplasty is an "Open Rhinoplasty" performed by an experienced Cosmetic Surgery after full consultation.
Revision Rhinoplasty for Asymetric Tip
I do think your a candidate for a revision rhinoplasty. You have an asymmetric tip because your lower lateral cartilages are asymmetric. The medial crura of the right lower lateral cartilage is deviated into your nostril and your left medial crura is over-projected. It also looks like you had a stair step incision rather than an inverted V incision for your 1st open rhinoplasty. That may have caused some issues with the mid-collumela as far as healing. Either way you are a candidate for an open rhinoplasty revision. Just make sure you choose an experienced rhinoplasty surgeon.