I had two rhinoplasties few years ago and was perfectly happy after second one. Since had breathing problem, decided to have medical surgery a year ago, which left my nose disfigured, it`s too short, too high, crooked and badly stitched. I haven`t recovered since. My first surgeon, who gave me my fantastic nose before, says it would be too risky to have another surgery and he doesn`t recommend it. We do fillers now, but I`m not very happy and want a lifetime solution. Shell I risk 4th surgery?
Shell I Risk 4th Rhinoplasty/revision? (photo)
Doctor Answers 5
Hello, and very sorry to hear about the negative result you have experienced from your most recent surgery. In general, I would not recommend having filler injected in the nose. I have seen too many complications arise. These complications may include infection, rejection by the body, asymmetry, and necrosis (the tissue dies). In the hands of a revision rhinoplasty specialist, a revision can help and improve the appearance of your nose. I would recommend seeking the opinion of a board certified revision rhinoplasty surgeon who uses computer imaging software. They can morph a photo of you and give you an idea of how the final result of surgery may appear. When looking for a surgeon, consider their experience, before and after photos, and patient testimonials. I hope this helps, and I wish you the best of luck.
Shall I Risk 4th Rhinoplasty/revision?
I have performed Rhinoplasty and Revision Rhinoplasty for over 25 years and from the photos provided aesthetically the nose appears to have the following issues:
- Over-resected nasal bridge and bones giving it a scooped out appearance. There may be an "open roof" deformity as well which would have to be diagnosed with a nasal examination.
- Over-rotated, nasal tip....this can be reduced with a localized Columellar Tuck that does not require a Rhinoplasty.
- The nasal tip and nostrils are asymmetric.
The contraindication for a 4th Rhinoplasty would be lack of blood supply to the nasal skin. It would be good to have one or both conchal ear cartilages left in case a cartilage graft is required. Lastly, when performing this difficult of a Revision Rhinoplasty, IMHO, it's better to have pinpoint laser focus of what can and should not be targeted for improvement in order to prevent any subsequent Rhinoplasty Surgery. You should consider several consultations with experienced Revision Rhinoplasty Surgeons.
Aesthetically speaking, the chin is very weak. You may want to consider a Chin Augmentation with a Chin Implant that would not only augment the chin but balance the entire lower face.
4th Time Rhinoplasty Surgery
Looking at the photos, I think you would benefit more from doing a formal revision rhinoplasty surgery. Obviously any final determination would require an in-person consultation. But I would certainly not recommend fillers to address the main issues that I can see. That being said, you need to consult with an expert in revision rhinoplasty surgery who has dedicated experience in managing this type of complex, challenging revision case.
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Multiple revision rhinoplasties, augmentation and lengthening
You could achieve improvement with a fourth rhinoplasty, third revision. There is obviously loss of support that will not be corrected temporarily or permanently with injectable fillers which only camouflage the problem. Because of the number of previous surgeries there is probably very little cartilage remaining in the septum that could be used to reconstruct your nose. This would more than likely necessitate the use of rib cartilage to strengthen the nasal dorsum and create a more natural and less turned up or infantile appearance to the nose. With the degree of apparent over resection, I would expect your nose to continue to deteriorate over time and encourage you to seek consultation regarding revision surgery relatively soon so that more permanent contracture of the skin envelope does not occur, which would compromise any revision surgery.
Extended Spreader Grafts for a 4th Rhinoplasty
Physical exam and nasal support determination as well as breathing status is always critical prior to a revision operation. An operation can be performed in which extended spreader grafts can be used to improve the dorsal aesthetic line and lengthen the nose as you want. The nostril asymmetry can be improved with a lateral crural strut graft. Once again, these are just a couple of suggestions. Always seek out a rhinoplasty surgeon who has perfomed at least a few hundred of these operations.