Revision Rhinoplasty

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Eyelid Surgery

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Hi there,
Thanks for your detailed question and providing excellent photos! I will preface this by saying there is no one-size-fits-all approach to rhinoplasty, and every surgeon will have a different preference that isn't necessarily wrong. 
In my practice as a Facial Plastic & Reconstructive Surgeon, I opt for septal cartilage for grafting when possible. It is a different type of cartilage on a cellular level than ear cartilage and tends to be straighter and stronger, and access is easy when already operating in the nose.
For some patients, especially those who have had a septoplasty or rhinoplasty previously, ear cartilage is the next best option. Depending on the location for grafting in the tip, the natural curvature can be a nice match for the nasal ala (nostril). I have had successful results using both types of cartilage in my surgeries.
I hope this helps provide a little insight and good luck! -Dr. H

Hi everyone I’m currently researching surgeons for my primary rhinoplasty and I’ve gotten two different opinions. One surgeon said he’d use septal cartilage, while the other mentioned ear cartilage. After watching a few videos, I’ve noticed some surgeons say ear cartilage is too flimsy for structure, but others seem to use it quite commonly. I’m a bit confused and would love some insight. For context, I’m mixed Asian and European. My bridge is more European, with a small bump I’d like refined, while my tip is softer and weaker. Does that combination make sense for preferring one cartilage source over the other? Is septal generally better for more support and definition, or can ear cartilage still give good long-term structure for the tip? Would really appreciate hearing from the experts :) Thanks in advance.

Ear Vs Septal Cartilage - which is best for a rhinoplasty? (Photos)

Hi there,
Thank you for your question! I see many young patients like you in my practice seeking early intervention for similar problems. In your photograph, it is difficult for me to tell if you are experiencing early bands in your neck from the platysma muscle, or true skin laxity. 
Banding can be treated with neuromodulators such as Botox before needing to escalate to a neck lift. Skin laxity responds well to radiofrequency treatments such as FaceTite. Ultimately, the definitive treatment for both would be a neck lift. Every surgeon defines a "mini" lift and "full" lift differently. I would not recommend liposuction in your case with your weight and volume loss. I suggest scheduling a consultation with a qualified surgeon to discuss in person.
I hope this helps and good luck! -Dr. H

Hi! I have an area on my neck where the laxity has been declining over the last couple of years. It almost looks as if it might be from weight loss, (I am 5'8 and have always been between 135 and 155 at most; am currently 138). I think about this area all the time and it's something I'm very aware of in photos, etc. Am I too young for a lift? Is there another way to improve this? Thank you in advance!!

How to approach improving my neck-- 35 years old and unsure if I would need a mini neck lift, full neck lift, lipo? (Photo)

Hi there,
Thanks for your question and for providing photos! I see many young patients such as yourself looking for early intervention to address similar issues! Fortunately, as you said, you have a great jawline contour and may not need surgery for a satisfactory result at this time. 
I would suggest starting small with focused, nonsurgical procedures, and working up to a mini lift if really needed. You may find that you're very happy with several sessions of microneedling and PRP to stimulate and tighten collagen, or even hyaluronic acid filler injection (such as Restylane or Juvederm) directly into the line to bring it up. 
In my practice, this is an area I commonly treat with FaceTite, which is a nonsurgical procedure that combines fine facial liposuction with delivery of radiofrequency energy into the lower face. Your last resort option would be a mini lift, but I do not think you need this.
Hope this helps and good luck! -Dr. H

I am 30 years old and have had marionette lines since I can remember- I have photos of me at 18 with them. They make me very insecure about my face. Weight changes do not make a difference- I have been very underweight and still have them. I feel that my face looks very heavy and saggy and I would like a lift. I don't think this is achievable with fillers. I like my jawline and most of the rest of my face, this is a big insecurity for me. Please let me know what options I have to fix this, and if a mini surgical lift will help. I will do almost anything to feel better about them. Thanks in advance.

Is there such thing as a "lower face" facelift to remove marionette lines? (Photos)

Hi there,
Thanks for your question and for providing photos! It's really helpful to see your area of concern. 
I will preface this by saying temporal brow lifts are one of the most common procedures I perform, and my patients love the results! BUT, a brow lift should be done to address a true problem with brow position for the best outcome, and results are more subtle than what you're showing in your photos. Your brows appear to be in great position already. 
If your primary goal is to create the illusion of a smaller forehead, the best procedure for that would be a forehead reduction (also known as a hairline advancement). This can very easily be combined with a brow lift if desired at the same time. Many patients worry about the scar, but this heals very well with time.
I hope this helps and wish you luck! Dr. H

Opinions on getting temporal lift ? I feel like it snatches my face up. I dont like my big forehead so maybe a temporal lift can give the illusion of a smaller forehead if my brow is lifted ? Thank you!

Temporal brow lift - will it give the illusion of a smaller forehead? (Photos)

Hi there,
Thank you for providing detailed medical history and photos! While I cannot see enough of your lower eyelid/tear trough in your bottom photo (which I assume is after surgery) to comment on hollowness, it does seem to me that you have a thickened eyelid muscle. This is called the orbicularis oculi and causes the appearance of the "jelly roll," so to speak. 
In many cases, this can be relaxed with a couple units of neurotoxin, such as Botox, in candidates that don't have lax eyelids. Also, when I perform lower eyelid surgery, I sometimes remove a small strip of this muscle if it is causing bunching or deformity. 
Your surgeon will be able to provide you with the best guidance, since he or she has examined you and performed your first surgery. Good luck and hope this helps!
-Dr. H

I had lower belph a few years ago that left me hollow under my eyes. I have genetic "jelly rolls" (the cute fat under-eyelid). But those cute jelly rolls (which I used to love) now hang down since they have no fat to rest on anymore. That skin has some aging as well since I'm 45 (but most people say I look 35). The eyelid is NOT pulling away from the eye at all, so there are no complication on that front. Also, as things settled, it actually appears a little bit hollow on the top inner corners of my eye socket area. My surgeon's usual method is to remove most fat and then use filler to fine tune, but we had a clear understanding with each other that I didn't want to use filler but that it would still be an overall improvement. And while it is an improvement, I don't recognize myself and feel like I look like a sad cartoon character. I'm considering going back to him for a revision w/ filler or possible ask about a skin pinch (so long that it doesn't totally remove my jelly rolls). I've looked into PRF as well and don't care if it takes many rounds if the results are good. From what I hear, fat transfer is unpredictable and my surgeon doesn't even do it for this reason.

Hollow after lower blepharoplasty - what is the best way to proceed? (Photos)

Hi Jenny, 
Thanks for your question. I can reassure you that it is fairly normal to see horizontal lines like this form over time. As the other providers have suggested, a neuromodulator treatment like Botox or Dysport is a great place to start to relax the muscles. This will prevent the lines from getting deeper and will also soften what is there. 
If you experience some improvement but find the lines do not disappear, skin resurfacing such as a laser treatment can have an additive effect. 
Finally, it could be that your forehead muscle is fighting gravity to pull up your brows, which descend slowly over time. You may want to consider a brow lift, which can be done in the office and has a fairly short recovery. This would not take the place of regular neurotoxin treatments but would enhance the results.
Hope this helps! Dr. H

I have this bizzare sagging of the skin. I am 46 years old.I do face yoga and use ice cubes to stimulate the skin and now the lines are getting deep and very many and now it is sagging.

Lines and sagging on the forehead - how can I fix this? (Photos)

Hi there! After any rhinoplasty, especially multiple revisions, it is very common to have altered sensation of your nasal tip and a "woody" feel. I expect the sensation of your tip will improve over the course of 12-18 months, and likely go back to normal, but it is a possibility that it will always feel a little different (whether that's numb or more sensitive). The stiffness or firmness should improve greatly over the next year, even after multiple revisions. However, the degree of improvement depends on whether grafting was done to your tip, what material (i.e. septal, ear, or rib cartilage) and how much was used, and exactly where/in what orientation it was placed. Sometimes I will consider a small injection of steroid after 3 months post-op to move this process along.
Regarding contact sports, unfortunately yes: your nose will always be more susceptible to injury than prior to surgery, especially if the bones were broken in (i.e. osteotomies were done) or grafts were placed to bring up your bridge or tip. I always advise my patients to avoid contact sports as much as possible and to wear a face mask if absolutely unavoidable. I wouldn't consider contact sports for an absolutely minimum of 3 months, but 1 year realistically. 
You are best served by asking these questions of your surgeon too, because only she or he knows your history and will be able to counsel you best! Hope this helps!

I was wondering does the nose stay sensitive and the tip firm forever? Do people who have rhinoplasty or multiple revisions after become more susceptible to getting injured easily from contact sports compared to someone who never had a surgery done? When is it safe to get back to contact sports?

Contact sports after multiple revision rhinoplasty?

Tania Hassanzadeh, MD

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African American Rhinoplasty

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