Bone Protruding Beside Nose After Rhinoplasty? (photo)

First, I would wait a sufficient amount of time, at least one year before contemplating a revision. Secondly, gentle massage will often help to resolve the excess bone or calcification that can occur after a rhinoplasty. Third, even in the best of hands, rhinoplasty surgery typically has a 10 to 15% revision rate. Finally, if you need a revision your original surgeon is usually the best to handle this since he is already aware of the anatomy of your particular nose. Good luck.

I would agree with others who recommend you go back to your original surgeon. This can be revised in some cases under local anesthesia. Time is also your friend in this situation. I have seen cases like this resolve on their own with simply the tincture of time. Wishing you the best of luck.

    If you would post views from the front and the sides and at 45 degrees in between, this would provide greater opportunity to offer advice.

Timeline is huge and I did not catch how far out you are. I like to wait at least one year before any revision work on the nose. Being that said if it has been 6-8 months and the problem is very clear such as the need to complete the nasal fracture I would do it sooner. Sure you may not have a complete osteotomy on the left but if it is early it may settle still. I would be up front with your surgeon. I do not know many board certified plastic surgeons or other board certified nasal surgeons who want a less than perfect outcome and happy patient. The biggest name is not always the best. However, I am sure your surgeon is great. You just need to be open with that person and I can promise you they will try to move the world to make you happy.

There does appear to be a protrusion on the left side of your nose in the area where a lateral osteotomy would have been performed.  You did not mention how long it has been since your surgery but this could just be an early change that will improve over time.  Express your concerns to your plastic surgeon.  A rhinoplasty is still a technically challenging operation.  If there is an obvious problem then most surgeons would do everything possible to correct the problem.  If the problem is an unevenness due to the fracturing of the bone then the correction should not be difficult.  

I am having a hard time visualizing from the photo the problem. But your description  may mean that the osteotomy was not completed. You  may need  a revision. Revision rates have been described from 5-25%, so it certainly is not a rare thing. Most revisions are for minor  irregularities.

The picture is very limited; however, any picture taken with in the first 6-12 months will be fairly limited, as soft tissue swelling can not be adequately assessed without a physical exam. When subperiostial dissection is extended this laterally, edema in this area is great and takes quite some time to resolve, as it is the only route for lymphatic drainage of the nose especially after an open rhinoplasty. It is unlikely that the bone itself is actually in a different position than preop, as an osteotomy this lateral would surely affect the drainage of your tears to your nose. If, on exam, this is not from edema then what you are see is a step off where the bone medial to the osteotomy has fallen too medial to the lateral edge of the osteotomy. If there is no airway compromise a simple filler to soften this transition zone is very aesthetically satisfying. This being said I urge you to leave it alone until a qualified nasal surgeon tells you the edema has resolved.

I would return to the surgeon who did the procedure first for his opinion prior to seeking treatment elsewhere.  He knows the situation better than anyone.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

 

Dear Mamatoalex, The photograph provided is a bit limited in offering the best advice. If you would like to post some further pictures to my email which is listed on my website below I would be happy to give you a better expert opinion. It appears by the above photograph that you may need an osteotomy on that side and that it was not done completely. As far as your other concerns some further photographs are necessary. Unfortunately just because someone is a professor in a prestigious medical school does not necessarily qualify them as an expert in rhinoplasty. Rhinoplasty expertise is a combination of excellent training and years of experience doing a lot of rhinoplasty procedures. Best regards, Michael V. Elam, M.D.