I Need a Revision Rhinoplasty. What Needs to Be Done to Make my Bridge Straight?

I had a closed rhinoplasty done over 2 years ago to remove a small hump and to refine a slight bulbous tip. I am very unhappy with my results. What needs to be done to make my bridge straight. Do I need sreader grafts? Or do I need the tip to be reduced or do I need both the tip and bridge worked on. Do collapsed nasel valves make the middle of the brigde look dipped and bigger? Im wondering if this is the issue because I have breathing issues through my nose and post nasel drip.

Doctor Answers (11)

Low bridge affects your nasal shape and funtion

+2

You have fortunately had a conservative closed rhinoplasty that limits your scarring and postoperative deformities.  This puts you in an excellent place for a revisionary procedure.

Your skin cannot shrink any more, which is why your nasal contours are blunt.  If your dorsum is raised by a a cartilage graft from your septum or rib, nice things will happen: your nose will look narrower and longer; your airway will at least double (based on my published airflow studies); your bridge contour will be more to your liking.

If your tip is also grafted, you can have more delicacy and shape, and tip grafting will also straighten your bridge line further.  Because your skeleton will now shape your skin, your nose will actually (paradoxically) look smaller.

Find a surgeon whom you trust , and who can show you corrections of similar problems that you like.  You want to maximize your chances of very good success next time.  Best of luck!


Nashua Plastic Surgeon
5.0 out of 5 stars 20 reviews

Breathing Problems and Depressed Bridge after Rhinoplasty

+2

I'm sorry your dissatisfied with the results of your original rhinoplasty. You do have a scooped-out bridge, an inverted V deformity, and possibly a pinced tip. Spreader grafts and grafts to augment your dorsum (prifile line) will improve form and function. You need an experienced revision rhinoplasty surgeon.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Polly-Beak

+1

Your picture looks like the nose has a "Polly-beak" deformity, which is a fullness over the tip. I would recommend having the fullness over the tip of the nose taken down and a slight build up of the bridge over the bone with a graft in order to get a straight nasal dorsom.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 36 reviews

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Correction of polly beak deformity

+1

You have the classic deformity of an over-resected nasal bridge  You should be able to get correction of this with cartilage grafting of your bridge, possibly using a rib graft

Sam Naficy, MD
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Revision rhinoplasty for dent in nose

+1

From your limited photos it appears that you have an over resected dorsum and collapsed middle vault. Augmentation grafting of these areas will restore balance and markedly improve your appearance.

You need to find a surgeon with experience at revision rhinoplasty and reconstructive techniques. Good luck!

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
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Revision Rhinoplasty After Mid-Vault Saddle and Inverted V

+1

Thank you for posting these photos, they are very helpful.  The reason you have this shape is the mid-vault (which is all cartilage) has collapsed.  This is because the cartilage that covers this area (upper lateral cartilage) attaches at two points - the nasal bones and the septum.  If it is detached from both and not supported, it collapses in and causes cosmetic plus breathing problems.

The solution is to re-suspend the upper lateral cartilages and place spreader grafts.  You would also benefit from dorsal onlay grafting to build up the profile of the nose (which shows a saddle deformity) and this will reduce the relative size of the tip.  You may not have adequate cartilage in your nose, so you should consider an ear cartilage graft.

With your appearance, symmetry and skin type, you can have an excellent result with proper revision.  I wish you the best in this endeavor.

Paul K. Holden, MD
Phoenix Facial Plastic Surgeon
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Correction of the Inverted-V Deformity in Revision Rhinoplasty

+1

Thanks for the question and for posting your photo. You appear to have what we call an "Inverted-V Deformity." Placement of spreader grafts during a revision rhinoplasty would appear to be beneficial for addressing your concerns with both the form and function of your nose. These are thin cartilage grafts taken from your septum (ideally), or ear/rib cartilage, if the cartilage from your septum has been previously removed. The idea is that by placing these grafts on either side of your septum, running the length of the mid-portion of the bridge, the upper lateral cartilages will be lifted outwards, improving the size of your airway and restoring a smoother appearance to the bridge. 

You should address your concerns with the surgeon who performed your initial surgery or consider a consultation with a revision rhinoplasty specialist. Computer imaging may be helpful for you to communicate the degree to which you want the height of your bridge changed, as this would determine whether additional cartilage grafts are required. 

Best regards,

Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Straightening bridge and improving congestion

+1

You do appear to have collapse of the middle third of your nose, giving you an inverted V deformity which can certainly lead to nasal congestion. Spreader grafts can help with this issue.

Your profile line can also be improved. I would suggest visiting with an experienced revision rhinoplasty surgeon to examine your nose and see what specific changes you would like done to your nose.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Revision rhinoplasty for nasal bridge and more

+1

The fact that your are experiencing breathing difficulty raises concern for internal nasal valve collapse and obstruction. It appears from photos that you would benefit from spreader grafts and additional nasal bridge modification (likely a small graft at the site of depression) to create an improvement in profile. Spreader grafts will help your breathing and appearance at the same time.

Narrowing of the valve region, as seen in your photos, is a known complication following hump reduction without placement of spreader grafts. However, there may be other reasons for your breathing difficulty, and a thorough nasal exam would be needed to ascertain all areas of obstruction.

Grigoriy Mashkevich, MD

Grigoriy Mashkevich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

I Need a Revision Rhinoplasty. What Needs to Be Done to Make my Bridge Straight?

+1

The dorsum is over resected and there is separation of upper lateral carilages from nasal bones causing an inverted V deformity and hence the nose looking wider in the upper portion. Spreader grafts will correct the middle vault problem as well as improvement in breathing and you will need dorsal graft to correct the ski slope dorsum.

Mohsen Tavoussi, MD, DO
Huntington Beach Facial Plastic Surgeon
4.5 out of 5 stars 9 reviews

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.