I'm wondering if I have saddle nose deformity. Do I need revision? (Photo)

Hi. The term saddle nose is used specifically when discussing a septum that has collapsed. It seems that although the surgery has created a similar appearance, it is more likely the result of an over aggressive lowering of the bridge (dorsum) and disproportionate tip projection. This can get worse with time as the skin continues to thin, swelling resolves, and the discrepancy becomes more visible. Increasing the bridge does require grafting and it seems that this may be necessary depending on your desired outcome and morphed imaging. Deprojecting the tip (bringing it lower / closer to the face) will also be important to bring it into proportion. Make sure to have a thorough consultation with someone who truly specializes in revision rhinoplasty, and clearly explains the expected outcomes. Good luck.

Your bridge is indeed far too low, compared to the position of the tip. Seems to me that your nose could be put into a very good position by bringing the tip back closer to your face (that's called "deprojecting" the tip) and by elevating the tip a bit, and by augmenting the bridge just above the tip. It may be surprising, but when the tip is put into good position, I'll bet that the bridge only needs to be built up only a tiny bit, and only *just* above the tip. That's good, because it's very hard to make implants along the bridge look natural.

How *much* to elevate the tip, or deproject the tip, or augment the bridge, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision, although I think we already have the answer to that one.