I had a septorhinoplasty performed 10 months ago and received subsequent Kenalog injections every couple of months due to scar tissue formation in the supratip area as well as the left side of the nose. My main concern has to do with the fact that my nose is still crooked and the tip is now twisted downwards to the left. What can be done at the one year mark to correct this without the same deviated result occurring again?
Septorhinoplasty and Still Crooked
Doctor Answers 9
Revision Rhinoplasty due to deviation
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Some deviation is common after rhinoplasty
Secondary Rhinoplasty Very Common
It seems as though your nose will require some attention from your surgeon. I would go back and talk to him or her about your situation in detail and then see if there is any hope for this to resolve itself. It may not. And if not, then you need to plan for a revision operation where the nose is straightened and the supratip deformity is improved. My bet is that you will need some cartilage grafts and an opening up of your tip. Good luck and make sure you get the right surgeon to help you with this operation.
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Crooked nose may need revision
Septorhinoplasty is one of the hardest surgeries, and is therefore left to surgeon specializing in such. I perform a significant number of revision rhinoplasties. Rhinoplasties are the mainstay of my practice. One of the things that I notice when I revise a nose is that many times the septum has not been adequately addressed even though the operative note states that a septoplasty was performed. The septum is the main tent pole of the nose. When the tent pole is crooked, the nose will be crooked. In such cases, a septal reconstruction is necessary.
Dr. Raghu Athre
Double Board Certified Facial Plastic surgeon
Residual septal deviation following rhinoplasty
Rhinoplasty is considered to be one of the most difficult surgeries in plastic surgery. Your nose composed of bone, skin, mucosa, and cartilage, and each of these tissues has different properties. Unfortunately, revision rhinoplasty is not uncommon. Studies indicate revision may be necessary in 5-30% of rhinoplasty procedures.
Revision, in general, should not be performed prior to one year following the primary procedure. Every physician is different, but I think revision surgery is best performed openly. This means an incision is made on the columella of the nose. This allows maximal visualization of the underlying anatomy. Occasionally, cartilage grafts may be required to be harvested from the ear if cartilage was harvested from the septum during the primary procedure. Rarely, rib cartilage is required. This is only necessary when other revision surgeries have failed.
Obviously, you would prefer that your next surgery be your last. So take your time looking for your ideal physician. You may need tip refinement with sutures, revision osteotomies, and spreader grafts to straighten the septum and to maintain it in its realigned position.
Crooked nose after rhinoplasty
Without examining you, it is impossible to give you individual advice as the photo doesn't provide a three-dimensional review. However, while there are many causes of crooked nose after surgery, including scar formation, graft displacement, imprecise surgical correction, facial dysharmony, and other causes, correction does not always have to entail more surgery. Sometimes precise corrections are more easily obtained with fillers. Hyaluronic fillers like Restylane, Perlane and Juvederm may work better in softer areas like the tip, while Radiesse may be a more optimal choice in firmer areas like the dorsum or bridge of the nose. It is best to discuss your concerns with your doctor and enquire about ALL options for correction, not just surgery.
Deviation following septorhinoplasty
If your nose is still deviated following septorhinoplasty, you likely will require further surgery. However, the photo does not clearly demonstrate the deviation. Can you post more views?
Nose crooked after rhinoplasty.
Without examining your nose it is difficult to say from the photo all that is deviated and how I would correct it. See your surgeon and if you are not happy see an experienced revision rhinoplasty specialist.
Revision Rhinoplasty After Previous Surgery
Rhinoplasty is a challenging operation and the revision procedure even more so. It is important to wait the full year after your procedure to ensure the swelling has resolved so that an accurate diagnosis of your problem can be made. From your limited photo, you have a slight depression at the middle 1/3 of your nose as well as the tip deviates to the right. This must be compared to pre-op photographs as well as in relation to your overall appearance. Limiting this to a single photo of your nose alone is an incomplete assessment. Obviously, nothing can be said without a side image to appreciate the "supra-tip" deformity.
Revision surgeries are possible and must be based upon a full inspection of your nose in the office of a board certified plastic surgeon. This being said, many times a revision surgery can make a significant improvement in the nose and frequently involves the need for additional cartilage from the ear or rib if the septum (inside the nose) has already been used. This may be something you want to consider with the complaints you have about your nose.
Best of luck
Vincent Marin, MD, FACS
San Diego Plastic Surgeon