What is wrong with my nose? (Photo)

Question

Hello, I had one rhinoplasty and one revision rhinoplasty with the same surgeon. First time I developed o poly beak and a second time i feel like I developed scar tissue and I might have a collapsed nose.

Steven M. Denenberg, MD · Answer

In general, to me, an attractive nose is a nose that doesn't have any features that draw unwanted attention to it, and of course the patient is the one who gets to make that determination. You didn't mention in detail what it is that you notice, but I'll give a couple ideas. In the 4th posted photo, the tip looks wide-ish to me. If that width is the result of the size and shape and position of the tip cartilages, then it's very likely that the width can be modified so the tip doesn't stand out so much. The third photo shows that the height of the bridge of the nose, in its lower half, just above the tip, is still too high, like a small pollybeak, and perhaps that can be lowered. The second photo shows the width of the tip and some big-is problem with the cartilage on the right side of the bridge of the nose. The first photo I think doesn't count because it's before your second operation, and we tend to only go by what you have right now.
Even though possible changes to your nose are small when measured in millimeters, they are difficult to accomplish with predictability unless the surgeon is quite expert, so you have to be very careful in deciding whether to have another operation, and you need your next surgeon to be persuasive that he knows what's going on, and what you want, and has the skill to accomplish it. Unfortunately, all that can be difficult to determine, I know.

Eric M. Joseph, MD · Answer

Three months is too soon postoperative to evaluate your results after revision rhinoplasty. Based on what I see, your pollybeak was lowered, and you have less tip projection and a much more pleasing nasal profile appearance. Your nose is a bit wide on front view, however, that may simply be swelling. Hope this is helpful! Sincerely, Dr. Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Depending on how far out from surgery you are now, you may want to consider a consultation for a revision. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Ruslan Zhuravsky, DO · Answer

Hello, I am sorry to see that you had two surgeries and still do not have the nose you desired. Those of us that do many revisions find that this is unfortunately more common than you would think.The main reason is that rhinoplasty is very different from all other plastic surgeries and requires someone that truly specializes in rhinoplasty. In order to get great results, you must first figure out the ideal aesthetic for each specific case, then understand the anatomy of what is seen from the outside, and finally have the right arsenal of techniques and maneuvers to be able to achieve the desired result. From these photos, it seems there may be a few issues that are finding unappealing. The first is the tip, which appears to have convex and cephalically positioned cartilages. This leads to a round tip appearance, excess fullness, and poor support around the alar rims (nostril margins). This has to be treated with very specific techniques that many surgeons find to be "advanced", hard to do, and require more time / effort, thus they do not often perform them. I find that this structure is present on a very high percentage of patients and needs to be treated properly. This is also a very common thing that I find in revision cases. The other issue seems that the midvault is overly narrowed / collapsed. It is hard to tell from this front view photo as it may be shadowing. This issue is often present from a destabilization of the support structures in the center of the nose and a lack of support such as from spreader grafts, spreader flaps, or simply reattachment of the upper lateral cartilages after a reduction. The good news is that these are all things that can be improved with a revision. It would require support from rib cartilage in order to enhance the shape and support of those areas, leading to an overall softer appearance that is in harmony with the rest of the face. However, it is VERY important that you seek out a surgeon with true expertise in revision rhinoplasty. Good luck!

Kailash Narasimhan, MD · Answer

And then personal exam would be necessary, but it may be that you require structure in your nose in order to overcome the forces of scar tissue. Again, Its impossible to determine without seeing you in consultation. When I perform a revision rhinoplasty is necessary to reshape the nose using some Cartilage material.

Kailash Narasimhan, MD
Narasimhanplasticsurgery.com

Kailash Narasimhan, MD
Narasimhanplasticsurgery.com

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