Unforunately I got butchered by an ENT. he used the tongue and groove. I think I have alar retraction on the left and right.I will probably need bilateral composite grafts. I want the sutures from the tongue and groove removed and my tip derotated slight. I want D-C fascia for the birdge bcause probably half of the height is chopped off this butcher. further i want deep temp fascia for dents on sidewals. I am very depressed its been 4 months. what else needs to be done to reach the goal pic?
Botched, Butchered Nose Need Revision Info Please? (photo)
Doctor Answers 5
I agree that butchered is a strong word. Also, don't blame the techniques used, blame the surgeon (if anything). The main issue I see is alar retraction. This might require composite grafts to fix, depending on what the internal nasal lining tissue looks like. You have more of a "pseudo hanging columella" than anything. There may be a slight actual hanging columella, but the main issue is alar retraction. I also agree with you that your bridge is somewhat low as well. Don't freak out. Your nose can be improved, but may require another surgery.
I do see the collumelar show and the alar retraction, I don't think it's botched and butchered. However, you can get a revision rhinoplasty to correct these things. I don't think you'll look like the soccer player though.
Relax and think clearly....
First off there is nothing "butchered" looking or "botched" looking about your nose. Yes it is not a great nose and yes you have alar retraction and septal show and a few other issues but no one can judge the results of a rhinoplasty without seeing your pre-op or starting pics. This may be a pretty good results or it may be a very poor result but it all depends on where your nose started off before your surgery. Also, your nose may be much worse in person than these pictures show but a botched or butchered nose is Latoya Jackson's nose so put things in perspective. But then again the perspective depends on your starting point. If this doctor caused Alar retraction then you have every right to be upset. You do need either LLC repositioning with alar strut grafts &/or composite grafts to bring down the nostrils. Other than that these pictures are not high quality and you are only 4 months out. You have to be patient and wait for a revision UNLESS all that you want are the composite grafts in which case you could get that done now. But dont think of your nose as 'butchered." Its not productive and in relationship to some of the horrific nosejobs that walk into my office for revision, yours is not good but not horrible!
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Tongue in groove, composite grafts, in dice cartilage fascia wrap in revision rhinoplasty
You've already described a pretty reasonable surgical plan. The tongue-in-groove technique itself is probably not to be blamed. You do have a hanging columella, and an appropriately placed suture could elevate it into a position more like your goal picture. Otherwise, composites, DCF, tip counterrotation, and fascia for irregularities sound like reasonable preoperative plans.
I agree that a revision will be necessary. However wait another 6 months before having more surgery. Your columella can be elevated and the nostril margins lowered with cartilage grafts. Rather than requesting specific surgical techniques consult with a revision specialist to discuss alternative approaches.
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