Reversing tongue and groove and fixing nostril length to gain a more balanced (non-operated look) is this doable?

Question

Unfortunately I am one of those that will have to reconsider a revision rhinoplasty. Besides reversing the tongue and groove which left me with no columella show and a sharp/spear like profile & a short/wide front view, my nostrils are too small! My nostrils are now a lot shorter in length which makes them rounder and wider but what looks the most off balance is my tip/nostril proportion...tip looks very bulky. Can this be fixed, maybe with pushing out the columella and infra lobular?

Alejandro Nogueira, MD · Answer

To begin with, the tongue in groove technique or gesture is an excellent surgical option in selected cases and expert hands, don't blemish its reputation! and don't blame it for your poor rhinoplasty result. As everything in rhinoplasty, the best technical option not properly executed or wrongly graduated leads for faulty outcomes.Actually, I can accept an unproperly executed tongue in groove technique might leave, among others, a sunken columella, an over projected tip or a flattened tip... but never ever makes any change on the tip size and shape; if you don't like your tip do blame the techniques applied there or their gradation.You are probabley a case for a complex nasal revision, so do research well good surgeons with solid experience in revision rhinoplasties.

Manish H. Shah, MD, FACS · Answer

Hello,Thanks for your question. Yes, under certain circumstances, it is possible to reverse some of the aspects of your rhinoplasty. There has to be enough tissue for mobility and a normal blood supply for optimized healing. It would be great if you posted pictures to show us what your nose currently looks like. 40% of my rhinoplasty practice is revision rhinoplasty surgery. I am getting more and more patients asking for these "reversal" type procedures, so you are, unfortunately, not alone. I think that it is very important for patients and surgeons to be on the same page prior to surgery. That is why I emphasize the use of preoperative imaging and conservative simulations. While simulations are not a warranty or guarantee of a particular outcome, they help in understanding possible outcome goals. I would be happy to discuss this further with you by Skype if you wish. Good luck,Dr. Shah

Christopher Khorsandi, MD · Answer

Without pictures it is nearly impossible to offer a reasonable opinion.  In plastic surgery many things can be done, but it depends on the tissue available.

Reversing tongue and groove and fixing nostril length to gain a more balanced (non-operated look) is this doable?

Answers (3)

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