Why are my nasal sidewalls still prominent 3 surgeries later? (photos)

Question

3 surgeries later, my nasal sidewalls are still prominent. My last surgery was a month ago. It was closed rhinoplasty. I assured the doctor to perform osteotomy and he said he did. However, my nasal sidewalls are still wide. I really want to know, how come three doctors couldn't narrow the sides that appear in the photo. They only appear under harsh lights. I really want your help in telling me why is it so hard for the doctors to narrow them. Your response is highly appreciated. Thank you

Andrew P. Trussler, MD · Answer

The nasal sidewall fullness that appears in photos and lighting one month after a tertiary rhinoplasty may be from residual swelling and/or incomplete osteotimies especially in the upper radix region which can make the fracture incomplete. If it feels soft in the area then it is likely swelling. If it feels like bone it may be incomplete in fracture.

George A. Toledo, MD · Answer

Your osteotomies appear to have been performed too high--in other words half way up the dorsum rather than very low on the maxilla and up to the corner of your eye. If your 3 surgeries were performed by the same surgeon, you should find someone else.  This is an easy fix. I have corrected this problem using an external approach with a small 2mm osteotome thus avoiding another complete Rhinoplasty.

Nima Shemirani, MD · Answer

Dear mys9,Usually it is because the osteotomies are incompleteFor the most narrow dorsum, you need lateral, medial and transverse ostetomiesI have found that most surgeons do not perform the transverse osteotomy which goes from the inner corner of the eye to the center of the nose, right where the nose starts.  This combined with the other 2 types of osteotomies will reduce the bonesMost surgeons typically perform a lateral ostetomy and try to crack the bone into place, but it does not work very wellBest regards,
  
Dr. Nima
  
Member, American Academy of Facial Plastic and Reconstructive Surgery
  
Board Certified Facial Plastic Surgeon
  
Board Certified in Head and Neck Surgery

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