I was told by many doctors not to do alar base reduction because it would look unnatural. I also notice asymmetries that make my nose slightly crooked and a droopy long tip in some angles. I know revision rhinoplasty is risky and I am scared after reading so many horror stories. What should I do that would be least risk but most result? Is the risk worth the reward? How difficult is this? I am nervous but I really want to find the right surgeon. Thanks
Had Rhinoplasty 4 Years Ago, Still I Feel Nose is Too Wide, Slightly Droopy and Slightly Asymmetric. What Should I Do? (photo)
Doctor Answers (6)
Fixing wide nostrils
Revision surgery is an option and in the right hands should be able to improve your nose.
Whether the risk is worth the reward is up to you. A consultation with an experienced revision rhinoplasty surgeon would allow you to get a better idea of your options and help you decide if surgery is worth it.
Revision of wide upper tip with hanging tip
The pictures presented are not adequate for a full evaluation, but it looks to me that the upper tip (lateral cartilaginous framework) is too wide and that the tip projection is too long. This can be corrected with a revision tip rhinoplasty. The only concern is what cartilage framework remains from the previous surgery. A cartilage graft could possibly be needed if the cartilages are too severely missing.
Loss of nostril wall support can make the nostrils look flared
If you saw me for a consult regarding flared nostrils a few years ago I would have said that the best way to treat it is to reduce the nostril flare (alar flare). Now we know more about revision tip surgery. What sometimes causes nostrils to look flared, yet they aren't really flared, is loss of support for the nostril wall. From the front the nostrils look almost "stuck on" to the nasal tip. The alar crease that is supposed to be above the nostril extends right to the edge of the nostril.
Restoring support for the wall is achieved by using grafts of your own cartilage. Adding support to the nostil walls not only smooths out the deep creases (alar creases) that seem to separate the nostril from the tip but allow us to make the tip as small as you would like and not sacrifice your breathing.
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Revision rhinoplaty is an option. Consult in person with your original surgeon and 2 - 3 additional expert and experienced board certified plastic surgeons to review your options. From these consultations, your surgeon and you will be able to determine if revision surgery is warranted.
Revision rhinoplasty for wide, droopy and slightly asymmetric nose
Asymmetries of the nose are best addressed by identifying the cause, such as lower lateral cartilages being more full on one side versus the other. The cartilages can be adjusted, sometimes sewn together, and occasional cartilage grafting is added to the weak side. This can also narrow the tip. A bridge can be narrowed with osteotomies and any further adjustments to the bridge can be performed at the same time. Thick, oily, olive complexion skin will require cortisone shots in the tip area during the first three months after surgery to address the persistent fullness.
You may be a candidate for a Non-Surgical Rhinoplasty to improve the appearance of your nose after previous Rhinoplasty Surgery.
I read your concerns:
We cannot evaluate your nose based on the limited photos you provided. If your tip droops, and if your nose is too wide for your taste, you may require revision rhinoplasty which is never an easy proposition.
You have slightly excessive nostril-show, and narrowness of your lower tip which makes your upper-tip look wide. You may be a candidate for a non-surgical rhinoplasty procedure to lower your nostril margins and to add some volume to your lower tip. I cannot know if this would be right for without examining you. My personal preference is to use Silikon-1000, an off-label filler for permanent results.
All the best.