Collapsed nostril / crooked nose. How is this corrected? (Photos)

Hello and thank you for your question and photographs.

First off, it's important to recognize that complications happen to ALL surgeons, and any surgeon that does not have complications or any suboptimal results is either not operating enough or lying.

With that said, although an exam in person is ideal, from your photographs alone, I agree that your nose is slightly crooked with an asymmetric tip and nostril collapse. I would recommend the following:

(1) Straighten the nose: excision/revision of any cartilage grafts already present in your nose with extended spreader grafts -- this can improve any crookedness, and add further stability to the tip by connecting to the tip complex. Moreover, by placing "sleek" grafts, this can also slightly narrow the nose overall. If the top (bony) third of your nose is also slightly asymmetric (or crooked), the surgery may also involve osteotomies (bone breaks) to narrow the bony portion of your nose.

(2) Stabilize the nasal tip: revision of the nasal tip with cartilage grafts to improve stability, symmetry, and reduce the risk of nostril collapse. Deprojection of the nasal tip can also add tension (and further sturdiness) to help with the overall integrity and stability of the nose. The surgery I perform to achieve this also involves excision of any soft tissue scarring, placement of a columellar strut graft connected to the extended spreader grafts (mentioned earlier) and placement of new extended alar contour grafts to stabilize the nostrils and minimize the risk of nostril collapse. I would also place a mastoid fascia tip graft (with additional soft cartilage) between the reconstructed tip complex and your skin to (a) reduce cartilage prominence (tenting up of the nasal tip skin by cartilage) and (b) to also create a feminine tip-defining point (subtle natural upturn).

To cut the long story short -- I would suggest a revision rhinoplasty and I am confident you can get the result you wanted -- improved tip symmetry without nostril collapse and improvement of any crookedness in the nose.

Due to your prior rhinoplasty, the cartilage in your septum was likely harvested and so you will likely require MTF (Musculoskeletal Transplant Foundation) aka cadaver cartilage to perform this revision rhinoplasty. Also note that if your septum is deviated and you have breathing difficulty, a revision septoplasty may benefit you as well, which can be covered by health insurance.

If you are at least 1 year out from your rhinoplasty, the skin has likely healed and is healthy enough to undergo a surgical intervention.

The next step for you is to pursue the right aesthetic plastic surgeon for your revision rhinoplasty. In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, in person, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. I also think a key component of your consultation is to establish a good connection with your plastic surgeon. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Plastic Surgeon

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. This can also be designed to straighten your nose. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon