I am going in for a reconstructive surgery from my same doctor to save money, but have some hesitations and concerns that he will not be confident in fixing this problem: 2 years post op and would like to get experts opinions on why my nose healed crooked (was not crooked before!) Is this common? What should I ask him when I see him? Also feel like the tip juts out and creates quite the hard triangle angle in pictures. How can that be fixed?
Why is my Nose Crooked After my Rhinoplasty? (photo)
Doctor Answers 7
Crooked nose following rhinoplasty
In general, it is very difficult to straighten a crooked nose, and it will not always be possible to get the nose 100% straight. Do you feel your nose is overprojected? This is something that can be fixed, and It would help to see side profile photos to provide you with additional advice. In general, every patient heals differently and a touch up may be necessary even after the initial procedure is performed correctly. When you see your doctor, it would be a good idea to ask the following things:
1) What will be performed during surgery to straighten the nose?
2) Based on my individual circumstances, should I expect to see an improvement following a revision?
3) Have you encountered this issue before, and if so, what was done to resolve it?
Ask your surgeon if they have a lot of experience performing revisions. If your surgeon can't help, they will refer you to the proper revision rhinoplasty specialist to ensure you obtain a result you are happy with. The more questions you ask the better, as it is important to have a game plan with your surgeon prior to having a revision. I hope this helps, and I wish you the best of luck.
Your problem is obvious and complex. Without all of the details (what you looked like before surgery and exactly what was done at surgery) it is hard to say what should or could (have) been done. You have also obviously lost confidence in your surgeon. The best thing for you to do now is see the surgeon again and get a specific diagnosis and plan of action from him/her. Then take your records, operative reports and photos to at least 2 other surgeons for the same. Then decide whether to go back to the original surgeon for clarification before booking surgery or pick another surgeon. This forum cannot substitute for seeing the 2 or more other surgeons face to face with your records.
If you try to save money now it may cost you a lot more later.
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 in order to know if this assesment is valid.
Crooked nose after rhinoplasty
On the front shot, I can't completely see your chin, but it appears that you have some facial asymmetry, i.e. your chin points a little to the left. Don't worry-- we all do. I always look at your bite and ask if you ever had braces. Our nose is like the roof on the house. The roof can only be perfectly straight if the foundation is, and that foundation starts with how your teeth come together (your bite).
You have to be aware of this preoperatively and be prepared to compensate for it or address the facial asymmetry directly.
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Revision rhinoplasty adds a level of complexity to rhinoplasty surgery. An exam in person would be helpful, but the curvature can usually be corrected.
The postoperative crooked nose
The most logical explanation for the postoperative crooked nose represented by your photographs is the over resection of your nasal dorsum with the disruption of the upper lateral cartilages from the septal cartilage and the possible persistence of a deviation of the nasal septum. With the dorsum of the nose is reduced the cartilage that makes the side walls of the nose is frequently separated from the nasal septum. As the nose reveals this cartilage may heal asymmetrically creating a deviation or the perception of a deviation because of asymmetries. To correct your deviation it will be necessary to perform cartilaginous grafting. Hopefully, this cartilage can be obtained from the nasal septum but it may require grafting from the ear or rib.
Re-evaluate your surgeon before you let him perform your revision.
Rhinoplasty is the most difficult of the facial plastic surgery operations. By far. And revision rhinoplasty is ten times more difficult than a first-time operation. And most surgeons who perform rhinoplasty probably shouldn't be doing the operation. It's not a commodity -- every surgeon doesn't perform the operation with the same skill.
Certainly, something can go wrong in any operation, even in the very best of hands. And having your primary surgeon perform the revision definitely saves money. But. You need to know whether things went wrong because of some unusual circumstance with the surgery or the healing, or whether things went wrong because your doctor was not expert in rhinoplasty in the first place. You need to evaluate your surgeon again. If you saw lots of before and after photos of other patients of his who got excellent results, in noses at least somewhat similar to yours, then your surgeon probably knows what he is doing, and you can consider letting him perform your revision.
However, if, on looking back, you find that you did not do excellent research on your surgeon -- you relied on a referral or some board certification without looking at his photos, the actual quality of his work -- then you probably should not have him perform the revision. If he couldn't get you close to your goal the first time because of a lack of skill, he will have no chance at all on the second try, and it will make it much harder yet for another surgeon to do the third operation.
The fact that the tip of your nose is still long and strongly protruding from your face is good and bad for you. It's good because, in my experience, raising the tip of the nose and bringing it back toward the face are two of the more predictable changes to make in a revision rhinoplasty. Also, when the tip is raised and deprojected, it gives more ways to correct the asymmetry, whereas generally asymmetries are difficult to correct.
It's not so good for you, because I find that most of the revision rhinoplasties that I perform are because of inadequate tip work in the first operation -- the tip is too long or too projecting. That might be a clue that your doctor is not the one to perform your revision.
Hope this helps. I know, it's a long response, but I wanted to get it all down because it might help someone else, too.
Revision rhinoplasty for the crooked nose, etc.
Revision rhinoplasty for the crooked nose, etc. involves adding cartilage to the areas that are depressed and straightening your septum. Choose a very experienced revision rhinoplasty surgeon to do this since this is more complicated than a primary. Look at photographs of many revisions that the surgeon has done.