I had a rhinoplasty in the 80s. The ENT filed off to much bridge bone and it is lower on the left that the right (I guess because he was right handed) Can this be leveled out w/o taking off more bone/cartilage? Thxs
Can Nose Be Leveled Without Losing More Cartilage?
Doctor Answers (6)
Modifying the nasal bridge
There are many options for augmentation, both surgical and nonsurgical. The most common nonsurgical option is a soft tissue filler like Radiesse, because it is immediate, has no down time, reasonably priced, workable, and can be precisely placed and sculpted. Usually that gives about a year of augmentation.
Surgery can be very directed, allowing multiple graft materials to be selected based on you and your surgeons preference. Most docs will opt for your own cartilage, first septum followed by others like ear cartilage or rib grafts. A synthetic material like expanded PTFE (goretex) has also had a reasonable track record, especially if prior surgery has compromised other donor sites (ie septoplasty).
So the answer is you have multiple options that would not lose more cartilage, but would more likely use material to bring up the bridge to a more natural height. Of note, the aesthetic that many docs pursued in the 1980's was of a lower height. Now we remove less structure and prefer a higher bridge. The goal of surgery is different today.
Rebuilding the bridge
It is difficult to answer your question without seeing more pictures – but most likely your bridge can be reconstructed using cartilage grafts
Rhinoplasty Irregularity Correction
Nose enhancement surgery most often leaves patients very satisfied with the degree of improvement. However, as with all cosmetic procedures, there is always a risk of slight imperfections, irregularities and aysmmetries.
Secondary rhinoplasty itself has risks and benefits that must be considered before embarking upon an attempt at a correction procedure. Some post rhinoplasty asymmetries can also be improved with a injection rhinoplasty (which also has potential complications), but in selected cases can be a simpler option.
A consultation with a board certified plastic surgeon or facial plastic ENT surgeon with skill and experience at all the secondary corrective options would be a good place to start.
Of course never embark upon a plan of action without a consultation with a certified specialist.
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Revision rhinoplasty with cartilage to level nose bridge
Since you have already had a rhinoplasty and asymmetry, there is a chance further augmentation of that side of your nose will be needed. Additionally, it may be easier to make sure the bridge is completely symmetrical and then add a symmetrical graft to the bridge to bring the bridge up equally on both sides. This is provided that you have cartilage left inside the nose, but if the nose is depleted of cartilage then ear cartilage will have to be used.
Nasal bridge modification
Modification of the nasal bridge certainly can be adjusted. Without examining you it is difficult to tell what you could actually benefit from. Certainly if there is an asymmetry this can be adjusted.
You may consider a Non-Surgical Rhinoplasty to level the height of your bridge.
If there is an indentation in your nasal bridge after previous Rhinoplasty Surgery, an Injectable Filler treatment may be an option to improve your appearance without additional surgery. My personal experience with Fillers is with Silikon-1000 for permanent results. Feel free to post / email a frontal and profile photo, and I'll be happy to share my thoughts with you.
If any of my colleagues wish to learn more about my experience with Silikon-1000, I am giving an instructional course at the upcoming Fall Meeting of The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). The course is titled "Off-Label Applications of Liquid Injectable Silicone (LIS)", and I will be presenting on 9/24/2010 at 4pm. Common conditions treated include: volume replacement, wrinkle reduction, lip enhancement, acne scarring, and correction of many nasal irregularities (“Non-Surgical Rhinoplasty”). I will also be describing the serial puncture, microdroplet technique that is essential for achieving desired results.
I hope this is helpful for you.