David C. Pearson, MD

Assuming you're otherwise in good health, it's usually possible to get the nose much straighter (though rarely perfectly straight) even when it's been a long time since the injury. Sometimes this can be done with injectable fillers at the expense of a slightly wider nose, but more can be done through a surgical rhinoplasty. I prefer the open approach since it gives greater control of other aspects of the nose. Also, make sure whoever examines you also carefully examines the inside of the nose for any deviation of your septum, which can affect how the nose is treated. All the best, --David C. Pearson, M.D.

While it's remotely possible that picking at your nose shortly after surgery could have provoked some asymmetries, it's more likely that it was either 1) present pre-operatively (take a close look at your surgeon's pre-op photos of your nose, or 2) a result of the surgical technique itself. Follow up with your surgeon to address these concerns and note that it's still healing at only nine months post-op. All the best, --David C. Pearson, M.D.

Correcting these under-eye areas like the tear troughs and orbital rims can usually be done with an injectable filler. Likewise, the temporal hollows can often be improved this way. I tend to start conservatively with a temporary hyaluronic acid gel filler like RHA, Juvederm, etc. These usually last quite a long time in these areas--often a year or longer--which allows a patient to see it from various angles and under various lighting and photographic situations. If they enjoy the results from these temporary fillers, I will sometimes recommend a more permanent filler like Bellafill. Rosacea can sometimes flare up with the use of fillers, however, so be prepared to treat the rosacea more aggressively if necessary with your dermatologist. I'm not a huge fan of fat transfer in these areas since they can sometimes produce some weirdly lumpy contours. All the best, --David C. Pearson, M.D.

From the two photos you've posted, it looks like the problem is a combination of an over-projected tip and also an over-reduced dorsum (the bridge). Although it's best to wait a full year before any definitive revision surgery is contemplated, there are some options in the meantime. One option might be to build up the bridge a bit with an injectable filler to conceal the exaggerated supra-tip break and better balance these proportions. The filler would need to be dissolved, though prior to any revision surgery. Revision surgery could later be used to de-project the tip (many techniques for this) and either build up the dorsum at that same time or use a permanent filler post-op. All the best, --David C. Pearson, M.D.

I prefer to do some computer simulations for my patients to help give them a realistic idea of what I think can be done with their nose with rhinoplasty, especially after assessing skin thickness. That way, we can also make sure that the patient and I agree on the overall size, width, rotation, projection, etc. of the nose beforehand. Of course, actual results will vary, but the simulations are meant to be pretty close to reality. All the best, --DCP Pearson Facial Plastic Surgery®

Ask your surgeon for specific recommendations, but generally speaking the recovery from a revision rhinoplasty should be similar to the first surgery. The exception would be if rib grafts were anticipated, which adds the nuisance of some chest discomfort and additional incision care. I usually let my patients do cardio at one week (running, hiking, etc.), but weights and heavy lifting should be delayed for at least two weeks post-op. Contact sports or any activity where the nose might get bumped should be avoided for at least six weeks. Hope that helps, --DCP Pearson Facial Plastic Surgery®

Rhinoplasty can address all of those concerns. I prefer the open rhinoplasty approach since I think this gives me better access and control of the cartilage of the tip and mid-third and it allows for more precise fixation of any cartilage grafts, dome sutures (to provide a narrower tip), etc. If you're thinking of having a rhinoplasty, meet with at least a couple of surgeons to get their opinions on what specifically can be done once they've examined you in person. Make sure the surgeon does a lot of rhinoplasty and that that is a focus of his or her practice. All the best, --DCP Pearson Facial Plastic Surgery®

Depending on your specific anatomy, it may be possible to widen the nose surgically with spreader grafts, onlay grafts, and other techniques. However, if the desired correction is minor enough, a non-surgical approach with injectable fillers may be a good option. In those cases, I usually start with a temporary filler like Juvederm to make sure that the patient and I like how it's going to look. If that's effective, then the results can be made more long-lasting with a permanent filler like Bellafill. I'll even use these fillers from time to time AFTER I've performed a surgical revision just to provide some final minor tweaks and adjustments. Best of luck, --David C. Pearson, M.D., Pearson Facial Plastic Surgery®

Your observations about your nose are accurate. Fortunately, these are all common problems that I encounter with patients' noses and these are all amenable to rhinoplasty. Generally speaking, the height of the dorsum needs to be brought down, the nasal tip needs to be de-projected (brought in closer to the face), the nasal spine may need just a little deepening, and the septum probably needs to be straightened since it seems like the right medial crural foot is winging out creating additional asymmetry to the nostrils. As long as you're otherwise healthy, have reasonable expectations, and find a good board-certified facial plastic surgeon, you're likely to achieve a nice result. All the best, --David C. Pearson, M.D.

"Diagnosis before treatment," as we say. You should probably see an ear, NOSE, and throat surgeon about this soon. He/she can better determine what it might be first (probably an inflamed or infected inclusion cyst). ENT surgeons also have the broadest expertise in the surgical management of the nose, as would a facial plastic surgeon. All the best, --DCP