Advice on revision rhinoplasty, is there anything structurally off? (Photos)

Question

I’m a 41 yr male who had a septorhinoplasty 6 months ago (nasal valve stenosis and turbinate reduction). My left nasal valve was the most problematic before surgery (near full collapse), and it continues to partially collapse especially when my right nostril is blocked/stuffy. My left nostril also continues to be swollen which contributes to the collapse (right side totally fine). Would like some advice whether there’s anything structurally off and if I should get revision rhinoplasty.

Nima Shemirani, MD · Answer

Hi @KakasA09. I recommend seeing an expert revision rhinoplasty specialist for an in person examination. There are several options for you that can be determined after examination. Rib harvesting is sometimes necessary in revisions if the septum and supporting cartilage of the nose have been weakened. This will give more strength and support to the nose. Best of luck, Dr. Nima!

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.  Although an exam in person is ideal, from your photographs alone it appears that you can benefit from tip refinement with reconstruction of your external nasal valve (nostril area) to improve/prevent the collapse you discussed.  Due to your prior rhinoplasty, the cartilage in your septum was likely harvested and so you will likely require MTF (cadaver) cartilage.  The modification of your nasal cartilage can be done with trimming, stitching or grafting.  If your septum is deviated and you have breathing difficulty, a septoplasty may benefit you as well.

Once all the swelling has resolved (in a year to a year and a half), 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, 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.  Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the 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 Aesthetic Plastic Surgeon

Donald B. Yoo, MD, FACS · Answer

During revision rhinoplasty it is common to add structural support by restoring elements of the nasal skeleton that were resected or removed during prior surgeries.  It is not uncommon to need rib cartilage as a source of straight, strong cartilage to rebuild a "collapsed" nose.  @drdonyoo

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! Thanks for the great photos and questions. It is possible that the valve collapse has not been fully addressed. Sometimes, strong grafting like lateral crural strut grafts are needed to provide rigidity to the nose. This rigidity resists collapse on strong inspiration. As well, the septum can be a contributor to the obstruction. This would need to be evaluated as well. I would revisit with your surgeon if you're comfortable to discuss options. Or, seek consultation with another for more opinions. Hope this helps you out!

Advice on revision rhinoplasty, is there anything structurally off? (Photos)

Answers (4)

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