Can my asymmetrical nasal tip be improved? (Photo)

Question

Hello I had one prior rhinoplasty 14 years ago, it was a closed rhinoplasty with no implants in the nose. The bridge is ok but I have a very asymmetrical nasal tip. On the left side my nasal cartilage is in a good position but on the right side cartilage is very droopy. It has stayed consistent for 14 years. I have consulted with several plastic surgeons who either tell me A) the tip of my nose looks good or B) it cannot likely be improved to be made more symmetrical. Is this as good as it gets?

Alan Gonzalez, MD, FACS · Answer

Hello @beautyqueen2023, and thank you for your question. Keep in mind that the nose like the rest of the face ages with time. The nose even when it has been operated is not always the same because the tissues tend to change over time due to gravity. This can be due to inflammation or other causes, for example allergies. The nose is one of the parts of the body in which one should try to intervene as little as possible. Just because you have one or several revisions of surgery does not mean that it will improve. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Gianfranco Frojo, MD · Answer

You need a very complex revisionary rhinoplasty. You should see an actual plastic surgeon (trained in plastic surgery residency and ideally aesthetic plastic fellowship) who specializes in rhinoplasty. Best of luck.

Andrew Miller, MD · Answer

Based on your photos, you are a candidate for revision rhinoplasty if it really bothers you. We would open up the nose and then try to align each of your tip cartilage so they sit equally. Be sure to see a rhinoplasty specialist for consultation.

Eric M. Joseph, MD · Answer

Perhaps your overall rhinoplasty results look unoperated, and your consultants aren’t comfortable with achieving a certain level of finesse. It is impossible to state much from one cropped photo, but you appear to have a wide, asymmetrical tip with flaring nostrils. Depending on your examination and what was done previously, revision may be considered. Thank you for your questions and I hope this helps. Sincerely, Dr. Joseph.

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.  Although an exam in person is ideal, from your photograph alone it appears that you have a subtle asymmetry and tip refinement may not be worth the "bang for your buck".  You may pursue a temporary improvement with nasal filler, but if you do wish to pursue surgical improvement of the collapse on the right side, I would recommend a lateral crural strut or soft tissue grafting to potentially improve it.  Other subtle tip refinement may also be performed at that time where further modification of your lower lateral cartilage is performed.  Due to your prior rhinoplasty, the cartilage in your septum was likely harvested and so you will likely require MTF (cadaver) cartilage.  The modification of your nasal cartilage can be done with trimming, stitching or grafting.  If your septum is deviated and you have breathing difficulty, a septoplasty may benefit you as well.

Once all the swelling has resolved (in a year to a year and a half), the next step for you is to pursue the right aesthetic plastic surgeon for your revision rhinoplasty.  In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

William Portuese, MD · Answer

Much more information is needed, such as a full set of facial and nasal photographs from all angles, since the nose is a three dimensional structure, rhinoplasty is performed in all three dimensions, and the nose heals three-dimensionally after rhinoplasty surgery. From these photographs, it's not worth the risk for such a minor asymmetry. Revision rhinoplasty is the most difficult procedure to perform correctly in the entire field of cosmetic surgery and revisions are always less predictable, especially when there is thick skin and scar tissue present in the the tip.

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Afternoon! Tip asymmetry can be challenging to improve but not impossible. In my experience, an open approach allows for precise tip work to be accomplished. The tip can be reconstructed via suturing and cartilage grafting material. The results can be quite nice. To assist with camouflaging, temporalis fascia can be laid overtop before closure. I would seek consultation with a Facial Plastic Surgeon to learn more about what can be accomplished. Hope this helps!

Can my asymmetrical nasal tip be improved? (Photo)

Answers (7)

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