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?
January 25, 2023
Answer: Revision Rhinoplasty 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
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January 25, 2023
Answer: Revision Rhinoplasty 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
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January 19, 2023
Answer: Tip Asymmetry 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!
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January 19, 2023
Answer: Tip Asymmetry 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!
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