Revision Rhinoplasty

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It appears that you have had some alar base reduction. This might be the reason for the breathing issues. However it is not possible to fully comment on it with clinical assessment.
Reducing the bridge may compromise breathing as well. 
Have you discussed with your operating surgeon? Even an over reduce alar base can be corrected (albeit with difficulty).

I had rhinoplasty and alrplasty 8 months ago. I still have difficulty breathing and after 3 months on steroid nasal spray, I was prescribed it again. I can’t see a visible slope and tip seems too low, nostrils too wide and tip too wiee- it is still hard and the sides alonf the tip.

I am having breathing and cosmetic issues eight months after rhinoplasty - should I consider a revision? (Photos)

This is a complication from the cartilage harvest rather than the possible haematoma. We should leave approximately 1cm of cartilage intact on the lateral edge of the concha. From the photos it appears as that concha was over harvested which led to the distortion. 
It is possible to reconstruct. However, it will require cartilage from the other side or rib cartilage.

Hi, I had a septorhinoplasty 6 months ago. The surgeon used cartilage from my ear for my nose. After a week, I noticed there was a hematoma, and part of my ear was filled with blood. Rather than draining it for me, the surgeon told me it’s normal and to just massage it away. Six months later, my ear is now deformed. I also think he took way too much cartilage from the ear because it is much flatter, and the inner part has collapsed. What are my options? Is this a common occurrence? I contacted a few ear surgeons, and they said this is very hard to correct and restore the ear’s original shape. Any advice is appreciated. Thanks.

Deformed ear after septorhinoplasty - how can this be repaired? (Photos)

Unfortunately the procedures you have had, do not at all help nasal valve collapse. The improvement you have is most likely from the correction of any septal deviation and the turbinate reduction to physically creates more space.
Internal and external valves are a very artificial concept that does not make much sense (I am writing a paper making that point). Better to think of it as an airflow limiting segment. This acknowledges that there are multiple areas and you should be carefully assessed to localise and provide the correct treatment. 
Your description suggests lateral wall collapse at the ala. A lateral crural strut usually does reliably improve this. It can cause a slight cosmetic change. 
The critical part is the in clinic assessment using a modified Cottle's test to identify which areas of the flow limiting segment is affected.

Hi there, I underwent functional rhinoplasty last year to address significant nasal valve collapse, particularly severe external valve collapse on my left side where the nostril would fully collapse on inhalation. The procedures included alar batten graft, alar rim graft (left side only), septoplasty, intranasal Z-plasty, and turbinate coblation. Since surgery, there has been some improvement. The external nostril no longer completely collapses, but I am still experiencing bothersome symptoms. There is persistent inward movement of the alar sidewall, especially around the junction of the alar crease and internal valve. This becomes more noticeable during exercise, and my sleep continues to be disrupted. It feels like there is still weakness in both the lateral wall and internal nasal valve. The operated nostril also appears structurally weaker compared to the other side. Before surgery, another surgeon suggested a lateral crural strut graft, and I am wondering if that may still be appropriate to improve support and airflow. My questions are: Can a lateral crural strut graft or similar technique still be performed after having an alar batten graft? Would this type of graft better address persistent alar wall weakness and dynamic collapse? Are spreader grafts likely to help in my case, given that my main concern seems to be lateral wall and alar weakness rather than just internal valve narrowing? In revision cases, is a combined internal/external repair suggested?

Nasal Vavle Repair - Alar Batten Failed - Any other options for me?

If it is the puffiness that is bothering you then it is some of the fat pads pouching out. This can be trimmed back without any sutures required. The slow dissolving sutured mentioned is usually when the fat is transposed to a different location. There is a another technique where a non-dissolvable suture comes out of the skin held on to a bit a felt. This is then removed at 7 days. 
Important message is that you do not necessarily need to have slow dissolving sutures.

Hi there I recently saw a surgeon regarding a lower blepharoplasty. He said I would be a good candidate but mentioned the procedure would involve dissolvable sutures along the orbital bone (just under the eye socket). I have anxiety and I hate the idea of a foreign object being left under my skin. I know it sounds ridiculous but it worries me. He said the sutures could take up 6 months for the suture knots to fully dissolve. He also said I could opt out of having the sutures along the lower eye socket but it means that area will look 'flat' and not as natural. Are there any other options to remove my eye bags which won't involve underskin sutures in that area? Thank you

Blepharoplasty options - Are there any other options to remove my eye bags which won't involve underskin sutures? (Photo)

Hey.
I am sorry to hear about your experience. Whether rib is needed or not really depends on what was done to the septum previously. The septum is very obviously still deviated which makes me wonder whether much was actually done to the septum. There is nostril asymmetry pre -op and that is unlikely to be completely corrected, however, a rim graft would make a significant improvement in the arched/notched appearance of the nostril. The tip rotation can be reduced quite significantly. I am suspicious of lateral crural malposition in your tip. This is something that can be corrected as well. 
Your concerns are real and mostly correctable. Whether a revision is needed is a matter of personal choice. If it is bothering you, then it can be addressed.

I had a primary septorhinoplasty in 2017 which I was initially happy woth. As the swelling subsided &amp; the final result was seen, that changed. The nose appears still deviated albeit slightly, the tip appears pinched as though too much cartilage was removed, my septum inside the nose bulges into the left nostril. The nostrils themselves are irregular shapes &amp; sizes &amp; the indent in the collumela is awful. I feel las though the nose is also quite upturned - more so than before the surgery. I have consulted with a few surgeons since the primary surgery. Some have said a rib graft would be needed to correct the issues &amp; others (including the primary surgeon) would not touch it. Is a revision needed?

Primary 2017 - deviated, pinched tip, irregular nostrils and columnella indent. Is a revision rhinoplasty needed? (Photos)

I am afraid that looks like that middle vault of the nose has been broken. This does not always look like a broken nose, especially after multiple surgery.

I had a revision rhinoplasty 12 years ago. I recently hit my nose with my thumb and 2 days later my breathing in my right nostril worsened. Externally I see a 'shadow' on that side just below the upper lateral cartilage. Has a graft shifted, collapsed in or is something else going on?

Can grafts migrate twelve years after rhinoplasty? (Photos)

This is an interesting question. Each time the osteotomy is done, the bone is weaker. However, addressing limited bony irregularities by a closed approach is common and fairly routine. Sometimes we can snip it off with a special scissor.

Hi All, I am hoping that you can assist me. I’ve had 2 rhinoplasty procedures of which both surgeons performed osteomotys. As there is a bone flare which can be visibly seen I was wondering what the risks would be in having an osteomoty only procedure for a third time to get it corrected? Also can this be done through a closed procedure? Thanks

How Many Osteomoty Surgeries Can Be Performed Safely?

I am truly sorry to hear that story. I am glad you are in a better place.
Most likely there are multiple fractures in the septal cartilage. The cartilage is quite easy to break. Given multiple trauma I would suggest total septal reconstruction with rib cartilage. This can more or less guarantee that the septum will be central. The bones will need to be manipulated as well. Most facial plastic surgeons do this kind of work routinely. 
Be advised though that the rib cartilage does make the nose quite a bit stiffer.

Hello, I’ve broken my nose very badly twice, and once only a mild fracture. These occurred while I was young(10, 14, 15 years of age). I’ve been living too long with this condition. My hesitation has been an apparent change to my nose physically, however, breathing through my nose has become too difficult, and this slight step off fracture which caused a lump on my mid nose. This would be more so a medical procedure. I’d just love to have it looked at, and check my options. My nose breaks occurred due to physical abuse. The man who did this, has now finally been removed from this world. When the extremely bad nose break occurred than knocked me unconscious for 2-4 hours, I remember the man immediately saying, “now you havr an excuse to get a nose job you’ve always needed”. I feel out of spite I never did get it fixed. Now, at 40, the breathing difficulty, and noticeable inability to draw on air especially on one side, has made me decide this is necessity. What I don’t know, is what options I have to correct the displaced fracture which left a small bump/ indent since it was first broken. I’m not sure what procure is needed

3 broken noses - Need help with airways in both nostrils. What procedure would help? (Photos)

Hopefully I will see you as a colleague in the future. Osteotomies are not always necessary with modern hump reduction techniques. If the surgeon is planning a structural septorhinoplasty then component reduction technique is used by filing down the bone or cartilage. The osteotomy is only needed if an open roof deformity is created. You do not necessarily create an open roof with component reduction. In practice, its difficult to know with absolute certainty whether osteotomy is needed or not. If mostly cartilaginous hump then spreader graft or autospreader flap is enough.

I (23F) am scheduled for a septoplasty/rhinoplasty + turbinate reduction in a month. I have a minor dorsal hump I would like reduced to be rather straight. I also would like a slight supratip break to mitigate a lengthened appearance and drooping of the tip. I have very thin skin which I know is a risk factor inverted V deformity. I really like how I look from straight on. I have a thin, straight dorsum and a nice tip. I don’t want to look much different from the front. My surgeon is a double board certified ENT and plastic surgeon. I want to keep my thin dorsum as much as possible, but instead he insists that osteotomies are only for large/moderate dorsal humps and he has instead proposed the use of spreader grafts. He has only one before and after photo on his website for rhinoplasty. The results are alright, not amazing, but I can’t make a fair judgement because the patient is just 10 weeks post-op and still has swelling. I’m wondering if I can trust him with this surgery? Will the results be aesthetically pleasing enough to go through with such an invasive, risky, and cosmetically uncertain procedure? I start medical school in a few months (I am also interested in facial plastics!) and I would like to breathe better, but I know that many surgeons harvest grafts from the septum. If it’s better to do both the septoplasty and rhinoplasty in tandem, should I just wait a few years being a bit uncomfortable with my breathing in order to find a different surgeon?

Getting a minor dorsal hump reduction, but my surgeon insists I won’t need osteotomies. Can I trust him? (Photos)

Thats an interesting question. Could be filler or some of the fat under the eye herniating out. An ultrasound scan can tell you with a good degree of certainty.
If filler then you could get it dissolved. If fat or granuloma then it can be removed surgically.

I had cheek filler done in December 2025 and in the past month or so I’ve noticed this bulging area in my upper cheek just below my eye that definitely wasn’t there before. Does this look like the filler had migrated?

Is this bulge in my upper cheek filler migration? How can I treat this? (Photos)

Gautham Ullas, BMBS, BMedSci, FRCS (ORL-HNS)

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Otolaryngologists (also called ENTs) specialize in head, neck, and throat surgery, making them qualified to perform functional rhinoplasties and other facial surgeries. Those who have also done a facial plastic fellowship can perform cosmetic facial surgeries.

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13 Answers from Specialist Registered Otolaryngologist Gautham Ullas, BMBS, BMedSci, FRCS (ORL-HNS) See Education, Board Certification, and Treatments Offered.

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European academy of facial plastic surgeons traveling fellow

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BMedSci (Hons) - University of Nottingham, UK.

BMBS - University of Nottingham, UK.

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Meet Gautham Ullas, BMBS, BMedSci, FRCS (ORL-HNS), a trusted Specialist Registered Otolaryngologist. See 13 expert answers, before-and-after photos, credentials, treatments, and  real patient reviews. Book a consultation today!

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