Revision/tip rhinoplasty wanted for uneven, cartilagey projection on one side of nose tip? (Photo)

Question

After rhinoplasty the tip flattens, then bulges out over one nostril, but not the other. Looks very uneven looking down on nose (smashed silly putty look) or from underneath. Tip projects in profile, worse from one side. Besides the obvious difference in tip sculpturing between sides, the profile has a ski jump slope that I think can be minimized if the tip could be more refined. I also think nostrils are too big. Are these issues that could be successfully resolved with tip rhinoplasty? Cost?

Umang Mehta, MD · Answer

Thanks for the question and photos. Your left lower lateral cartilage (tip cartilage) appears to be sitting in front of the cartilage on the right, creating what's called a bossa. The two cartilages could be separated and brought together in a more symmetric fashion with sutures. Once this is done, any other asymmetries can be corrected with shaving the cartilages, reshaping them with sutures, or adding grafts. The two cartilages could also be brought in closer to your face which would reduce the tip projection, the distance that the tip sticks out from the face. This can also change the shape of your nostrils. I like to set my tip position with what's called a tongue-in-groove suture or septocolumellar suture. Essentially this maneuver secures the tip cartilages to the septum, which should be a fixed point on the nose. This suture is a powerful way to control the rotation (up-down position) and projection of the tip. This makes the tip position more predictable over time. I'd recommend consultations with a few plastic surgeons who specialize in revision rhinoplasty. Ask to see noses like yours and make sure they are communicating their surgical plan in detail. All the best,Dr. Mehta

Bahman Guyuron, MD · Answer

While a tip rhinolasty would be the main objective from your revision rhinoplasty there are some other minor flaws to your a tip rhinoplasty with combination of restoring symmetry and lower the projection of the tip on the left side along with adjustment of the nostrils would create much more natural shape to your nose.

Evan Ransom, MD, FACS · Answer

Thank you for the photos and your question. Yes, revision rhinoplasty can help with these issues. Your tip cartilages appear a bit asymmetric and the tip of the nose is slightly overprojected. Please meet with a few surgeons before deciding on the best course of action for you.

William Portuese, MD · Answer

There are several asymmetries regarding the tip of the nose which will require suture techniques and cartilage grafting to make the nose look more symmetrical and natural in appearance. The fossa can also be shaved down the tip of the nose to make it look less pointy.

Samir Shureih, MD · Answer

See Dr. Bahman Guyuron, chairman department of plastic surgeryCase western Reserve University, Cleveland

Revision/tip rhinoplasty wanted for uneven, cartilagey projection on one side of nose tip? (Photo)

Answers (5)

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