I'm bothered by the tip of my nose ( hanging and non-symmetrical ) after a primary rhinoplasty 10 years ago (Photo)

I'm bothered by the Tip of my nose ( hanging and non-symmetrical ) after a primary rhinoplasty 10 years ago. I dislike how droopy the tip is, but more so, I dislike how the left nostril "squeezes" in - hard to explain, but feels like the surgeon took out too much cartilage from the left side. The right side I like, but still droopy. What's the best fix? Would this secondary rhinoplasty be complicated? As you can see in the photos the right side is much better than the left,

Doctor Answers 5

Revision rhinoplasty candidate

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 Revision rhinoplasty is harder than a primary rhinoplasty due to the fact that there is previous scar tissue and alterations to the anatomy. Revision rhinoplasty is also one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery, so it's important to choose your surgeon very wisely based on extensive experience producing natural results. It's also important to know whether the are not there is any cartilage left on the inside of the nose for grafting purposes. The asymmetry in the midportion of the nose can be addressed with a spreader graft, a dorsal augmentation may also be required with a cartilage graft and the tip can be lifted. It's also important to release the depressor septi ligament( If present) which pulls the tip down when smiling.

Revision rhinoplasty

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Based on your photos you may expect significant improvement with revision rhinoplasty. However, this is most frequently more complicated and skill dependent procedure than primary rhinoplasty. For that reason you need to find a reputable plastic surgeon, nose specialist, for detailed clinical evaluation and discuss your options. Good luck.

Zoran Potparic, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 19 reviews

Hanging Asymmetrical Nasal Tip

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A revision rhinoplasty can be done to treat your asymmetrical tip with a hanging columella, as well as correct your asymmetrical/deviated bridge and saddle deformity. Consult with an experienced revision rhinoplasty specialist so you achieve a natural result with a complicated problem.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

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Revision rhinoplasty

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The nose is off balance with a low. crooked bridge and long tip. Crooked noses do have different profiles or 3/4 views.
You need the  tip rotated up and cartilage grafting to restore normal anatomy.
If you have a good straight piece of septal cartilage for a dorsal graft, this will correct the low dorsum and the crooked nose (probably from an internal valve collapse).

Revision Rhinoplasty Consultation and Nasal Valve Collapse

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Your questions and observations are excellent and I believe that you would benefit from a revision rhinoplasty with cartilage grafts via an open approach. Tip ptosis, nasal length, columellar asymmetry and profile enhancement can be achieve by an experienced Facial Plastic Surgeon with special interest in revision rhinoplasty. You likely may need tip modifications, strut graft, middle vault reconstruction with spreader grafts and other revision options. Your case is complex, but by selecting the appropriate specialist, you should expect nice improvements. 

The left nostril "squeeze" that you describe sounds like you suffer with external nasal valve collapse from over resected lower lateral cartilages. This creates an inward concavity of the nostril with inspiration. An exam can confirm this diagnosis. Repair of the valve is called repair vestibular stenosis, and this can be done at the time of your revision procedure. I would schedule a complete consultation for exam, photos and imaging. It is best to candidly review your aesthetic and functional goals and ask your surgeon for his/her recommendations. 

Congratulations on pursuing recommendations for nasal enhancement. Best wishes.

Fred J. Bressler, MD, FACS
Houston Facial Plastic Surgeon

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.