In June '10, I got a nose job (narrowed bridge, fixed hump, tip refined but I have thick skin). It's better BUT I find now it's asymmetric(crooked?). Below the bony part, it seems to deviate a pinch to the right. I'm seriously considering revision but I'm wondering if it would be easy for a surgeon to straighten it out or if I'm putting myself at risk of ruining the improvement I've achieved so far. My guy thinks the crookedness is tissue-related & may not be correctable by surgery; 2nd opinion?
Revision Rhinoplasty: Worth It For What I'd Like To Fix? (photo)
Doctor Answers 7
Revision rhinoplasty - asymmetric tip
You certainly have asymmetry of your nostrils as well as your overall nose. Pre-operative photographs may help to determine if the problem existed before surgery but the real problem is dealing with the nose you have now. Both the interior framework of your nose as well as the outside of you nose would need to be assessed in order to determine the cause of your asymmetry. Once that has been determined, an accurate operative plan can be developed and a successful revision rhinoplasty can hopefully be performed.
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A crooked nose can be caused from a multitude of different issues including the nasal bones and the upper lateral cartilages. When the nasal bones are crooked, osteotomies must be performed to straighten the nasal pyramid. Spreader grafts, which are composed of the patient’s own cartilage, are used to augment the concaved side of the bridge in the midthird of the nose. These spreader grafts are harvested from cartilage on the inside of the nose and are placed underneath the upper lateral cartilage to firm and bolster outwards the concaved side. They also improve airflow through the nose.
Revision of Asymmetrical Nose
You do have an asymmetrical nose which can be improved with a revision rhinoplasty if done by an experienced surgeon. Only you will decide if the procedure is worth it - that's a very personal question. Unless your 'guy' is a surgeon, listen to a revision rhinoplasty specialist.
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Crooked nose after rhinoplasty
The tip does deviate slightly to the right, but it looks like it's over more than it actually is because the middle one third of the nose is lower on the right. On the third picture submitted it you can see a slight depression to the upper lateral cartilages. Take your hand and cover the tip of the nose and look above and you will see what I am talking about. just below the nasal bone. The tip cartilages may need to be tweaked a little, but you will probably also need a spreader and/or onlay graft on the right to fill that depression out. You are only 5 months out, so give your nose a little more time to let all the swelling go down.
Crooked nose after prior rhinoplasty
The deviation of your nose to the right can most likely be improved with a revision rhinoplasty. Seeing preoperative photos would be helpful in assessing your situation, but even if it were present before your prior surgery, it can still be improved.
I wouldn't necessarily say that this is "easy" to do, but in experienced hands the nose should be able to be made straighter while maintaining the other improvements you've already achieved.
I would refer you to look at your pre-op photos as well. Many times the asymmetry was there before th surgery.
Answer to RealSelf.com Rhinoplasty revision question
Thank you for the photographs and question. It appears from your pictures that your tip deviates slightly to your right. It would be helpful to know what your nose looked like before your rhinoplasty and whether or not you had septal surgery during your rhinoplasty. Without an examination and further information, it is not really possible to answer your question. It does appear that the lower portion of your septum deviates to your right. This could potentially be improved with seriously affecting your overall results. I would recommend that you obtain a second opinion from another rhinoplasty surgeon with a face-to-face consultation. Good luck.
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