Gregory Branham, MD

Early after surgery  you are going to have swelling that will take time to resolve.  Having said that, however, you should notice significant improvement in the overall shape and configuration of your nose postoperatively. It is essential that you talk to your surgeon about your concerns.  Not knowing what you had done, I cannot comment on the specifics of your surgery, however you should be seeing improvement as the sweling continues to improve.  Again, it is essential to have a good relationship and the ability to communicate freely with your surgeon regarding your concerns.  if there are complications or problems with your rhinoplasty you want to find out what the plan is to correct them and what the time frame is for doing so. 

There can be a number of reasons that a surgeon might refuse to do surgery.  If the surgeon felt that your expectations were unrealistic or that their experience would not permit a good result then that is not the surgeon for you.  Not every consultation ends with a surgical plan.  I would suggest that you see other rhinoplasty surgeons and that if you have not done so; that you be as specific about what it is that you want to accomplish in changing the shape of your nose.  Any examples of ideas that you have, you should bring along to the consultation.  Finally, I believe that preoperative imaging is essential to allow you to see what the surgeon is contemplating and to confirm that it complies with you desires. 

You have a fairly common problem that we see in young individuals who inherit a tendancy for early puffiness of the lower eyelids.  This is fat that is bulging out due to a weak orbital septum.  In cases like yours, a conservative transconjunctival blepharoplasty should correct the problem.  In some cases, a prominent tear trough deformity also exists and this may require fat or filler injections to help camouflage this depression.  In your case the tear trough or transition zone from the thin eyelid skin to the thick cheek skin is not deep and should be fine after blepharoplasty.  Best of luck. 

While hyaluronic acid fillers like Restylane and Juvederm can fill and soften facial features, care must be taken when injecting it into the skin and soft tissues of the nose.  Because you have thin skin, the fillers are very unforgiving and will add bulk and fullness.  Also they are not permanent and will require reinjection at 9months to a year.  If you decide to go with fillers in the nose, small amounts should be injected with vigorous massage to make certain that you don't get irregularities from the filler.  Obviously, this is not an FDA approved use for the filler materials, but it has been done before. 

I understand your desire to not alter the tip of your nose, however, if you remove the dorsal nasal hump it will actually make the nose appear longer because the bump on your nose breaks up the length of the dorsum visually and makes it look shorter.  If you have the bump removed you should have the tip rotated upward to shorten the overall length of the nose as well.  To do this you don't have to make the tip smaller or do any other major alterations to it, but your nose will appear longer unless you alter the tip.  Good luck

Allergies are caused by a defect in the nasal mucosa.  Rhinoplasty won't change the allergies per se, but can improve the overall nasal airway and thus lessent the congestion and stuffiness associated with the allergies postoperatively.  If you require medication to control allergies now that will not likely change after surgery. 

Your right lower lid is significantly lower than the left and the lid margin is below the inferior limbus (or lower border of the iris).  You should have this re-evaluated to see if there is something else that can be done to correct this.  The status of your graft should be  evaluated and the cause of the lid malposition determined.  Your lid crease is also higher on the left which also contributes to your lagophthalmos.  Another opinion is in order.  You should look for an ophthalmic plastic surgeon or oculoplastic surgeon in your area. 

The photos don't tell the whole story.  It is difficult to know if you have too much cartilage or persistent swelling.  Certainly after one month you will stil have some swelling and it will take some time for that to go down.  It is always best to see the surgeon who placed the implant to get the best answer as to what your nose will ultimately look like.   If you are worried and are not able to see the surgeon (since he/she is in another country) you should see someone to have this evaluated.  There can be problems having surgery abroad if you are not able to participate in the necessary follow up.  Your surgeon should ascertain whether you are able to do this prior to surgery so as not to leave you with this kind of problem. 

Regarding diced cartialge, it depends on specifically how it was placed as to what its fate will be over the longterm. 

There are many causes for eyelid asymmetries.  It is important to have this evaluated to make sure that you don't have something more serious.  Some level of asymmetry is normal and is seen in the eyelids and other facial features. 

If you are a year out from surgery then there is not much that is going to help you with the problems you describe (wide nose, persistent bump, deviated septum) except more surgery.  Unfortunately you will need a revision surgery to correct these things as they don't generally improve with additional time, especially after a year.  Correcting the septum can improve your breathing.  If done properly it should not affect the extenal appearance of the nose.  If not executed properly it can have deleterious effects to your appearance.  Narrowing the bridge of he nose is usually done with osteotomies or "breaking" the nose and narrowing it. 

You will need to assess how much these issues bother you and if they are worth going through another surgery.  Good luck.