During my primary surgery the doctor removed too much of a dorsal hump. There is some pain on the boney bridge area when I push on it and feels bumpy and irregular. He performed a lateral osteotomy without using spreader grafts and now my nose looks sunken in at the bone region and to thin. It also feels like the nasal bones are really really short. What is causing this and can this be corrected with a revision?
Can a Lateral Osteotomy Be Reversed?
Doctor Answers 7
Collapse middle nasal vault
From the one photo you posted you appear to have collapse of the upper lateral cartilage. This is a common finding after dorsal hump removal, especially if a prophylactic spreader graft isn't placed.
Fortunately, this is something can can be addressed with revision rhinoplasty surgery. I would suggest you visit with a revision rhinoplasty specialist to examine your nose and give a full assessment of your options.
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Reversing lateral osteotomy
It is very difficult to reverse a lateral osteotomy. The osteotomies can be reversed, however, you may end up with more of a flat top or square top nose known as an open roof deformity. The best option is to perform medial osteotomies to open up the nasal dorsum and place extended spreader grafts in them to improve the width of the inverted V and pinched upper lateral cartilages. This gives much better definition in dorsal aesthetic lines and reduces that pinched-in appearance.
Issues after Rhinoplasty.
Your photos seems to show a mid vault collapse which could be corrected with a revisioin Rhinoplasty. You might want to have this converstaion with your Rhinoplasty surgeon and see how he/she wnats to proceed.
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It is difficult to give you a detailed answer without better pictures or a thorough examination. It appears you have an inverted-v deformity secondary to a mid vault collapse. Cartilage and fascia grafts are usually necessary to revise a nose when too much has ben removed. Consult with your surgeon and/or get a second opinion from a physician experienced in revision rhinoplasty.
You don't give a timeframe for your surgery and your pictures are limited but do suggest some midvault collapse. This can be corrected with spreader grafts and if needed osteotomy and onlay grafts as well. Talk to your surgeon or see someone with extensive revision experience.
Your pictures show depression at the upper lateral cartillage where it meets the nasal bone. Possible seperation of the upper lateral cartillage. The bony pyramid seems ok.
Correction of seperated upper lateral cartillage is difficult.
Talk with your surgeon about your concerns.
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.