Small depression in nose after Primary Rhinoplasty - What are my options? (photos)

Question

I had a primary septoplasty / rhinoplasty about 2.5 months ago. Once the swelling went down, I noticed there was a small dent / depression on the right side of my nose. It shadows in pictures, which has made me avoid them at the moment. I've been instructed to massage the area above every day, and we're watching it carefully. I'm worried this depression / shadow will not go away. What is happening here? What are my options? Looking for some additional opinions. I love my results other than this!

Shim Ching, MD · Answer

At 2.5 months after your surgery, it is difficult to say whether this area will persist or not.  Swelling is never uniform and swelling could be responsible for the concern that you see.  I would wait the full year, longer if this is a revision rhinoplasty, to see if this issue remains.  In the meantime, if this really bothers you, temporary fillers such as Juvederm could be used to minimize things.Aloha,Shim Ching, MD

Michael Dobryansky, MD, FACS · Answer

At only two and a half months post op it is still early and there is definitely still swelling present in your nose. Even if this issue persists, it will likely be able to corrected with a low volume injection of a dermal filler. Just follow the instructions of your surgeon for the time being...

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  It is very normal to be swollen in the postoperative period.  The dorsal aspect of the bridge of the nose will usually decrease earlier than the nasal tip swelling.  Nasal tip swelling can sometimes take 6-12 months to fully resolve.  I advise patients that the final result of rhinoplasty takes 12 months.  I recommend that you return to see your surgeon, as he/she will have a good idea of what to expect in regards to your specific progress, since they can evaluate you in relation to your preoperative appearance.Best wishes and good luck.Richard G. Reish, M.D.Harvard-trained Plastic Surgeon

Clark Schierle, MD, PhD, FACS · Answer

A nonsurgical rhinoplasty using injectable fillers can do wonders for small issues like yours. Whereas these fillers are temporary and only last six to twelve months in areas where there is a fold made by movement like around the lips, in our experience in stationary areas like the nose, they can last much longer, two years or more.

Steven Wallach, MD · Answer

At 2.5 months your nose is still swollen and will take a while for it to stabilize. You need to give it a good year or more for the swelling to subside.

Michael Bowman, MD · Answer

Thank you for your question.  It is normal to have subtle changes in the nose for up to a year after rhinoplasty as some of the swelling takes quite a while to go away.  The massage is fine to continue.  The good news is that the contour you are talking about is probably not as noticeable as you think it is (i.e. we are our own worst critics).  Most people will not take notice of that irregularity, so I hope you are able to get out and not worry about any social repercussions of this area.I would definitely keep in touch with your primary surgeon and give it a little more time.  Ideally, I would recommend waiting a year, but if you still are very concerned about things at 6 months postop, I would consider a "liquid rhinoplasty" touch up.  This is where your surgeon can use a filler to take care of this, usually without any significant recovery.

Peter E. Johnson, MD · Answer

It is too early to know just  what the approach should be. Though we might be skeptical that the dent will disappear it will be several more months before we know for certain. At that point if a revision is needed there will be options for you.

Fred J. Bressler, MD, FACS · Answer

Thank you for sharing your concerns about the small right sided dent on your nose after rhinoplasty. It is too early in your recovery to know if this is going to persist and need surgical attention, but the indentation is in the area known as the middle nasal vault and may represent an issue with the position of the right upper lateral cartilage. If the swelling of the nasal bone above continues to improve and the "indention" remains stable, then all should heal well. Sometimes however, your right upper lateral cartilage needs to be supported with a cartilage spreader graft placed surgically. If, originally, your surgeon placed spreader grafts in the middle vault, then perhaps a larger, wider graft would have worked better. Grafts can sometimes "slip" too low and cause an indentation there because it no longer matches the other side. Fortunately, these are rather straight forward issues that can be managed with a future minor revision. Congratulations on loving your results otherwise and maintaining what sounds like a good, professional relationship with your surgeon about your concerns. Please continue to follow your physician's recommendations and keep up with your future follow appointments and examinations. Hope this answer helps.

Alex N. Mesbahi, MD - Account Suspended · Answer

The dent you are concerned about is in the area where there is a transition between the nasal bone above and the cartilage below. It is a very common area for this to happen. As the swelling subsides over several months, it may become more noticeable.  The good news is that simple placement of a filler can take care of it without the need for additional surgery. I would recommend that you wait several months before addressing it and I always use a hyaluronic acid filler in the nose. These types of fillers can be reversed with another type of injection in case you are not happy with the result.  Best of luck with the rest of your healing !Dr. Mesbahiinstagram: @mesbahimd

Small depression in nose after Primary Rhinoplasty - What are my options? (photos)

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