What revision would be best suitable for my nose? What should I do next? (photos)
Doctor Answers 7
Hi Smmm398 and thank you for sharing your concerns. I would suggest having another consult, expressing your concerns with your surgeon to see what options are there for you. A revision is definitely recommended to straighten your nose, remove the "bump", and softening of your tip. I would also suggest a second opinion from an experienced revision rhinoplasty specialist. I wish you the best of luck!
It should be possible to get you much closer to your goal.
See the "Web reference" link, just below my response. I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.
I lowered that bump, and brought the tip and the entire nose back a little closer to your face. Your forward projection of the nose, how far it sticks out, is not extremely strong, so only a small movement there is required.
Since your operation would be a revision, and since the changes you want to see are small when measured with a ruler (even if they are large in how much they bother you), it's absolutely crucial that you and the surgeon are on the same wavelength as far as the goals of the operation, and his explanation to you about what is actually possible. Don't have a disappointing operation because of a lack of communication, and end up looking for a third procedure.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle. Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon. Specifically, whether your primary surgeon should perform your revision, and how in general to tell whether a surgeon has the skills you need.
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
Your nasal bones have an asymmetric fracture, causing one to 'slant' as you said. This would be addressed with another osteotomy on the side marked with your blue arrow. The residual bump on the top of your bridge is due to either asymmetric resection of nasal bone and septal cartilage, or a shift in the cartilage away from the bone. This can be fixed with either bone rasping, septal repositioning, or wrapped diced cartilage augmentation, depending on your aesthetic goals. The tip will require a little crushed cartilage to soften it's appearance.
Best of luck!
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You describe your goals or what you want very well. First I would discuss your concerns with your surgeon. Second I would get additional opinions. Additional opinions are beneficial to you and most likely will help in your decision making process. In your case, I would recommend an open rhinoplasty to get as close as possible to the shape and look you are going for.
Revision rhinoplasty and what to do next
- I am sorry that you have to consider a revision, it's something no patient wants to go through
- Based on your pictures, it looks like your bones are off-center, and they should be brought back into midline
- This might also fix the indentation which might be there because the bones are crooked
- You can shave the bump relatively easily
- You can also soften the tip by trimming some cartilage
- When you are ready, please see a revision rhinoplasty specialist who can address your concerns
Revision Rhinoplasty? What Next?
You have been patient; it s time to consider a revision. First I would discuss your concerns with your original surgeon. It might be beneficial to get a second opinion from an experienced revision rhinoplasty specialist. Some observations after reviewing these pictures; it appears that you have increased width of the bridge, a residual hump, asymmetry with depressions in the mid portion of our nose, increased width of the tip, possibly a short nose that is over-rotated. All of this should be considered and discussed during consultation.
Of course i would need to see the nose in person to make a final determination but the a revision will straighten your nose and speaker grafts will fill the depressions. The bump can be removed and your other goals should be discussed regarding the tip. Your surgeon can do this or if you have lost faith in him see a very experienced revision rhinoplasty surgeon and look at his results with revisions.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.