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Septorhinoplasty and Still Crooked

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?

Doctor Answers (9)

Revision Rhinoplasty due to deviation

+3
In reviewing your photograph it is difficult to determine the cause and complete severity of your deviation. The deviation may be due to septal problems if they were not fully addressed in the primary procedure but this is difficult to determine without a full examination of the inside and outside of the nose. I would go back to your surgeon and discuss your concerns. You will need to address if you are having any breathing difficulties or if they are cosmetic only. I would make sure that you go to a surgeon who is skilled in revision rhinoplasty as you want to make sure this is your final procedure. I do many revision rhinoplasty procedures in my practice and you need to make sure you are in the hands of a skilled surgeon with lot's of experience. I wish you the best and remember it is best to wait a full year in to the post operative phase before the revision is performed.


Orange County Facial Plastic Surgeon
5.0 out of 5 stars 123 reviews

Some deviation is common after rhinoplasty

+2
I feel your frustration. After you go through a surgery you want everything to turn out perfectly. To address your case would require more photos showing your full face and additional angles. Looking at your prep photos as well would be helpful. Potential causes of nasal deviation after surgery are many and include: uneven osteotomies, collapse of one of the nasal bones, unequal healing of the nasal bones, uneven removal of bone or cartilage, uneven cartilage grafting (onlay or spreader), uneven scar capsule formation, persistent septal deviation, warping or twisting of septum following the surgery and pre-existing facial/nasal asymmetry. As you can see there are many factors that can cause a crooked nose after surgery. Some of these factors are controlled by the surgeon, some can occur after the surgery. If a skilled and experienced rhinoplasty surgeon performs your surgery I think the most common cause of nasal deviation is preexisting facial/nasal asymmetry. Patients are often unaware of their facial unevenness as they have been looking at their face their whole life. I think the consultation where we go over the patients's photos and explore the subtle facial asymmetries that most people have is very important. At that time we can go over how much improvement is possible using imaging software. So, first I would talk with your surgeon, go over the before and after photos and discuss what can be done. Realize that getting crooked nose straight can be very challenging. I hope this helps.

Ivan Wayne, MD
Oklahoma City Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Secondary Rhinoplasty Very Common

+2

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.

Jay Calvert, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 23 reviews

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Crooked nose may need revision

+2

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

Houston, TX

Raghu Athre, MD
Houston Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Residual septal deviation following rhinoplasty

+2

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.

 

Good luck!

Jason R. Hess, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 7 reviews

Crooked nose after rhinoplasty

+1

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.

Michelle R. Yagoda, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Deviation following septorhinoplasty

+1

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?

Arian Mowlavi, MD
Laguna Beach Plastic Surgeon
5.0 out of 5 stars 6 reviews

Nose crooked after rhinoplasty.

+1

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.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Revision Rhinoplasty After Previous Surgery

+1

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

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 26 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.