What procedures can restore the nose closer to its original size and shape? Small or large revision? (Photos)

Question

Male Septorhinoplasty over resected dorsal hump, issues breathing, nose shortened and thinned (not wanted). Unhappy with results. May 2023 septorhinoplasty aimed to enhance breathing and side profile, maintaining nose length and size. Post-op at 6 months, issues include nasal valve collapse, excessive narrowing, undesired length decrease, flattened bridge, altered tip shape. Result too different from computer simulation causing severe emotional distress. Seeking advice from plastic surgeons: What procedures can restore the nose closer to its original size and shape? Small or large revision? Possible to still look natural?

Mats Hagstrom, MD (license on probation) · Answer

Your situation is unfortunate. I recognize that you’ve already had the procedure and are looking for guidance in regards to revision surgery. For those who have not yet had surgery, I want to emphasize the importance of properly selecting plastic surgeons before committing to having surgery. Delivering consistent quality results of any surgical procedure is not guaranteed because somebody has board certification, decades of experience or good reviews. Certain procedures are inherently more complex and difficult than others and rhinoplasty surgery is definitely one of those more difficult operations. to find the right plastic surgeon for your needs. I recommend patients always have multiple in person consultations before choosing a provider. The biggest mistake patients make is having one consultation and then scheduling surgery.
During each in person consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar facial characteristics to your own. And experience plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. Highly experienced surgeons should have access to 100s or preferably thousands of before and after pictures. Being shown a handful of pre-selected images, representing only the best results of a providers career is insufficient to get a clear understanding of what average results will look like, what your results will look like or how many of these procedures the surgeon has actually performed. 
I recommend patients bring pictures of their own face to use as reference when reviewing before and after pictures. The time to be critical of plastic surgeons is before you schedule surgery. 
There’s no correct number of consultations needed to find the right provider. Some of it is simply based on luck, or how well you prescreen before making a list of potential providers. Recognize that being famous has a little to do with being talented, and there are plenty of exceptional plastic surgeons, who have very little Internet profile or recognition in regards to number of reviews etc.
The best plastic surgeons will be detail oriented and not rush through doing their work. This means they should spend plenty of time during surgery and the consultation process. You may want to ask each surgeon how long the anticipate the operation to take and why?
Revision surgery is often much more difficult and complex than primary procedures. Reducing and knows is much much easier than adding volume. Restoring the inappropriately removed previous tissue will require harvesting graphs. This is complex reconstructive work that should only be done by those who have extensive rhinoplasty experience. In your case, I would follow the above recommendations, but ask specifically to see before and after pictures of secondary rhinoplasty surgery. Since you’ve had a previous septoplasty, your septum may not be a good source to harvest sufficient amount of cartilage. Ask each surgeon where they plan on harvesting Cartlidge and why.
Generally speaking, patients should not undergo revision surgery within the first 12 months after rhinoplasty. Jumping into secondary procedures is a big mistake. Even though you know you need a rhinoplasty revision it’s a mistake to have the procedure prematurely. You also need a significant amount of time to find the right provider. I generally don’t recommend people travel long distances for surgical procedures, but sometimes it may be necessary, if the availability of skill in your community is limited. 
Regardless, I recommend patients avoid the temptation of having virtual consultations whenever possible. For a situation as complicated as your own. You definitely need an in person consultation. You should also get copies of your operative report and may as well get the entire medical record.
You may want to take a look at the rhinoplasty Society membership, pages to see if any members are in your area. Being a member of the rhinoplasty society does not mean somebody is talented and rhinoplasty surgery, but those who make an effort to join the society most likely have a strong interest in rhinoplasty surgery, and their membership does include, lots of very talented, rhinoplasty surgeons. It’s probably an overall excellent source to begin finding the right provider. 
I’m sorry you find yourself in this situation. Please be careful in your selection process and have faith that in the right hands, your nose can be restored, and while it may not come back to the way, it was before surgery. It has a potential of being improved.
Best,
Matt Hagstrom, MD

What procedures can restore the nose closer to its original size and shape? Small or large revision? (Photos)

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Everything you need to know about Revision Rhinoplasty

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What procedures can restore the nose closer to its original size and shape? Small or large revision? (Photos)

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.