Wide Bridge. Do I have an open roof deformity from my primary Rhinoplasty surgery? Any insight is greatly appreciated!

4 months post op from primary rhino/septo surgery. Hump removed, nostrils made smaller, tip refined. Bridge of nose is now wider & looks crooked. Issues 1.) Bone on right side is pushed up toward my eye causing a shadow. 2.) Skin on right side is sunken in and airway completely restricted creating an dent in middle right side. Right side looks pinched. 3.) Left side bone is curving out. 4.) Nostrils different sizes. What is going on? Can it be fixed? Will it get better or worse over time?

Doctor Answers 8

Concerns after Rhinoplasty

It is difficult to answer all of your questions with looking and feeling your nose.  With just the pictures, I will do my best to answer your questions.

First, the nose will continue to change over the first year.  It will look different over the next 8 months.  It may look better, worse, or the same.  It is impossible to predict.

In reviewing your pictures, it appears that you may not have adequate support of the middle aspect of the nose.  It is called an inverted v.  This can cause the nose to look crooked and wide.  This can be repaired during surgery by adding support by cartilage grafting.  The grafts are called spreader grafts.

The narrowing in the middle aspect of your nose can cause nasal obstruction.  This could would be relieved by spreader grafts as previously mentioned.

The pinch on the tip would like need to be corrected with cartilage grafting as well.  Typically, lateral crural strut grafts work best in this area.

I would be patient and see how your nose heals.  I would see a revision rhinoplasty specialist about 10 months after your initial surgery to start the process if you are considering additional surgery.  I would get your operative reports from you rhinoplasty doctor and take with you during a consultation.

I hope this helps.  

Post-operative concerns

It appears you had quite a number of elements of your nasal she changed during your primary rhinoplasty. You would definitely still have some swelling in the middle third and tip area. The width of the upper third (bony component) of your nose may not appear as narrow as your pre-operative photographs long term.

When a large dorsal hump is removed generally spreader grafts are indicated to add support to the mid-third and prevent any collapse at the junction of the bones and cartilage in that area over the years. This can sometimes add a little extra width to that area.  I suspect your first surgeon felt these were necessary. 

I would recommend waiting 12 months to allow for more swelling to resolve. If you are not happy with the width of the nose in the upper third the bones can be re-shaped at that stage and any slight asymmetries from the healing process addressed. 

Jason Roth, MBBS, FRACS
Sydney Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Depending on your examination, you may be a candidate for osteotomies to narrow your nose on front view.

It's impossible to judge swelling in your photos. Everyone is swollen four months postoperative, but most of the remaining swelling is typically in the tip. That said, I have seen narrowing of nasal appearances over the course of a year.

If your bridge is still wide in two to three months and is continuing to bother you, repeating osteotomies could be considered depending on your examination. That could potentially improve the indentation on your right bridge.

Your tip looks nice, and slight asymmetries may be from swelling.

Hope this is helpful for you.

Dr Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 397 reviews

Wide Bridge. Do I have an open roof deformity from my primary Rhinoplasty surgery? Any insight is greatly appreciated!

There is MUCH more than just an 'open roof'. But you can try non surgical filler rhinoplasty now to give a more refined appearance. This HA filler injection would need to be done on a 9 month basis. Or a secondary surgical revision surgery in a few more months.

Revision Rhinoplasty

Hi,

You have outlined many issues and some of them are obvious on the photos... I do think that some of the irregularities can be fixed but would require an in office consultation or at least a phone consult along with pics. Seek several opinions before making any decisions.

Best,

Dr.S.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 265 reviews

Revision nose

HapyCat, It's too early to get too excited about your final result but let me point out a couple of things to bear in mind. First, I do not recommend alar rim surgery in conjunction with primary rhinoplasty; it should be staged. the main reason for this is changing the tip will in almost all patients change the shape of the nostril in an unpredictable way leaving the surgeon guessing as to what extent they should change the shape of the nostril. I don't like to guess. Secondly you are R sided dominant and for that reason will always have some minor asymmetries.  It does look like you had a high osteotomy on the R unfortunately. Seek the opinion of an experienced expert at about 6 months. Search the Internet. Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.8 out of 5 stars 45 reviews

4 months post op. some advices:

Thank you very much for enquire.
It's too early to make value judgments with only 4 months after a rhinoplasty.
Swelling after a rhinoplasty depends of the surgery complexity.
In this regard, the nasal swelling Post-op It can last from two weeks to two months.
To reduce this swelling, I recommend you perform delicates daily lymphatic drainage massage therapy over the face (around the nose) avoid sun exposure, and take pain/inflamation pills, as your surgeron precribe you.
Kind regards,
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 178 reviews

Post Rhinoplasty Evaluation

Thanks for your post and photos. Even though you are still very early in the recovery phase of your rhinoplasty, I share your concerns about the issues you outlined in your questions. It is difficult to diagnose exactly what is going on without the benefit of an in-person consultation and examination. Preoperatively, you had a dorsal hump deformity and a thinner bridge. Your increased width appears to be related to a number of factors. I do not think that you have an open roof deformity, but you appear to lack proper position of your upper lateral cartilages following removal of your hump. If you did not have cartilage spreader grafts to the middle vault originally, this could become worse over time. 

Fortunately, your concerns can be corrected via a revision by an experienced Facial Plastic Surgeon. In time, if you remain unhappy about your nose, I would consider having a revision. You will likely require cartilage graft reconstruction with spreader grafts, osteotomies of your nasal bones and tip reconstruction rhinoplasty with cartilage grafts. In my view, any future revision is best done through an open approach rhinoplasty. 

My final comment would be to discuss your concerns with your surgeon or search for someone else with special interests in revision rhinoplasty for an examination and further recommendations. If possible, I would allow at least 3 to 6 months before having a revision rhinoplasty. Hope this answer helps you.

Fred J. Bressler, MD, FACS
Houston Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

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.