Dent/gap in dorsum after revision rhinoplasty. Could this be my skin "shrink wrapping" unevenly? (Photo)

Question

I have had two rhinoplasty surgeries by the same surgeon, I love the shape of my nose but I have developed this dent in my dorsum. I am about 11 months out from my revision rhinoplasty surgery, and this just started showing about 1 month ago. It feels like a bone separation when I touch it. Could this be my skin "shrink wrapping" unevenly? I'm willing to travel anywhere to a surgeon that can fix this without filler or undergoing another full revision :D

Nima Shemirani, MD · Answer

Hi @Rhinoplasty92762. Thank you for sharing your photos. This looks like it might be a combination of a gap between the bones and thinning of the skin. I would fix this by adding a spreader graft and adjusting the nasal bones if necessary. At the conclusion of the case, I would use soft tissue like fascia to thicken the skin and avoid this issue post operatively.

Best of luck,

Dr. Nima

Andrew Miller, MD · Answer

You do appear to have a small dent, and while that can be corrected with more minor surgery, it's not necessary to go through that. I assume you don't want filler because you have to keep repeating it. But silicone can be used as micro droplet injections to fill it in permanently. Be sure to go to an expert injection for consultation.

Steven M. Denenberg, MD · Answer

I agree that filler isn't great, because it'd be temporary. And really, any non-filler solution would involve surgery to get up into that area, and that would make it a real revision, even if the changes were more limited than your first operation(s).
I would need to know better what is causing the dent. For example, if the left nasal bone is still sitting in a wide-ish position, that could cause the dent, and then moving the edge of the bone that sits along the bridge of your nose closer to the midline could go a long way toward closing the dent. 
The photos you posted were all frontal views, which makes it hard to tell the width of the nasal bones -- 3/4 views are better for that.
Also, a dent is a depression between *two* prominences. The other prominence is the midline of your nose, the part of the septum that sits right in the middle of the bridge. Some of the views make it look as though that edge of the septum is also somewhat prominent. Profile and 3/4 views could show whether lowering that sharp edge of the septum is possible, something good to determine because lowering the septum along the bridge could contribute to decreasing the dent. 
Sorry this all seems so complicated, but noses are like that. I think the main issue is what I described at the start: that we need an excellent evaluation of what is causing the dent before it can be best treated.

Philip S. Schoenfeld, MD, FACS · Answer

You are correct.  There is a gap between cartilage grafts that were placed along your nasal dorsum during your revision surgery.  The easiest way to remedy that issue would be to place a cartilage, temporalis fascia, or both along the irregularity without having to go through a complete revision surgery that might create other issues,  It would not be nearly as invasive as your prior surgical procedures.

Eric M. Joseph, MD · Answer

Since you are 11 months after your second nasal surgery, nearly all of your swelling in the nasal bridge is gone. You appear to have a linear indentation along your left nasal sidewall. Depending on your examination, microdroplet Silikon-1000 may be considered for permanently filling this area. Hope this is helpful! Sincerely, Dr Joseph

Dent/gap in dorsum after revision rhinoplasty. Could this be my skin "shrink wrapping" unevenly? (Photo)

Answers (6)

Answer: Dent in the dorsum of the nose

Answer: Dent in the dorsum of the nose

Answer: Would you consider a permanent non-surgical nose job?

Answer: Would you consider a permanent non-surgical nose job?

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Dent/gap in dorsum after revision rhinoplasty. Could this be my skin "shrink wrapping" unevenly? (Photo)

Answers (6)

Answer: Dent in the dorsum of the nose

Answer: Dent in the dorsum of the nose

Answer: Would you consider a permanent non-surgical nose job?

Answer: Would you consider a permanent non-surgical nose job?

Browse related questions

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.