Opinions: 1st plastic surgeon wants to graft cartilage to make the more contoured side fuller, fix my deviated septum which everyone has said is why my nose is crooked & to do this by OPEN rhinoplasty.2nd wants to remove cartilage to make it match the contoured side,smooth out the bones,add one piece of cartilage to the bridge to reduce the 'ski slope-iness' of my nose doing CLOSED rhinoplasty.3rd said that not to touch the bones,just add cartilage to make the contoured side fuller, OPEN. Help?
Is It Possible to Contour One Side of Nose Cartilage While Maintaining a 'Blended Look'? (photo)
Doctor Answers 7
Contouring one side of the nose
Rhinoplasty to address asymmetry of nasal cartilage
Spreader grafts are placed on the concaved side of the midthird of the nose when there is a differential in the profile. If there is a severe convexity to one side, then shaving the high side down to match the concaved side will also be performed in addition to the spreader graft. Spreader grafts are a patients own cartilage, harvested from the internal portion of the nose and placed along the bridge line to improve the profile and symmetry. Repair of a deviated septum itself will not effect the outside portion of the nose and is simply performed only for improvement of airflow dynamics through the nose. Both of these procedures can be performed through closed rhinoplasty techniques.
Closed with Tip Reduction and Sanding
The closed obviously avoids the scar. Removal of tip cartilage has less variability than the placement of a graft. Sanding makes sense as does the cartilage graft. If the scoop does not bother you, then no cartilage graft necessary. The female nose tends to look more scooped out than a male nose, but that is, of course, your decision.
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Experienced rhinoplasty surgeon will select the correct steps.
Just going by your pictures, I would vote with surgeon #1. But, believe me, this is not the right way to decide what to do.
Surgical options for rhinoplasty
First, thank you for the photos. You mentioned several treatment options recommended by different surgeons but you didn't mention your specific concerns about your nose. It's more important to hear what you like and dislike about your nose. Do you have a clear idea of what you want your nose to look like? Make a wish list and then go to the surgeons and ask each one how they would address your surgical goals. The surgical plan should match what you are trying to accomplish. There may be more than one treatment plan that can help you achieve your goals and it's critical that you feel comfortable with both the surgeon and the plan.
Is It Possible to Contour One Side of Nose Cartilage While Maintaining a 'Blended Look'?
Sadly, you will get different opinions that can vary widely as you seek advice during a Rhinplasty consultation. The aesthetic judgement varies among Rhinoplasty Surgeons as does their level of training, experience and ways of doing the same thing. You, as the consumer, are left to sort all of this out and make a decision which I understand is difficult at best.
Aesthetically speaking, from the photos provided, the nose is a bit wide across the bridge with a slightly lowered "scooped" nasal dorsum. The nasal tip is asymmetric with a fullness on the right that extends into the supra-tip region. This may be excess cartilage and or subcutaneous tissue. The tip is close to the maximum rotation at 110 degrees and IMHO, would be over-rotated using an Open Rhinoplasty technique.
A Closed Rhinoplasty could thin and refine the nasal tip without filling in the left side (remember onlay grafts add volume so in this scenario, your tip would be wider, not smaller which does not seem aesthetically correct IMHO). The bridge can be raised if you like and the sides, of the nasal bones rasped making them more narrow. Hope this helps.
Thanks for your question and photos. Best of Luck!
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