Crooked Nose One Year After Septo-rhinoplasty, If This Possible to Fix?

A deviated nose after rhinoplasty may be a result of multiple factors which can include underlying deviation, technical issues during the surgery.  Rhinoplasty is a highly complex operation where fractions of millimeters can make a big difference.A deviated nose is one of the most challenging endeavors for rhinoplasty surgeons.  Patients should have the expectation that the nose will look improved but not perfectly straight.  Since every deviated nose is unique, the procedures required to fix it will vary from patient to patient.  Here are some reasons for persistently deviated noses after surgery:
1.  Swelling-  It can take up to a year or more for swelling to resolve.  Swelling can have an impact on how the nose looks.  Early on it may be difficult to see how the nose looks until swelling resolves.
2.  Incomplete correction-  Under correction is one of the most common results after repairing a deviated nose.  If the result is from persistent deviation of the bone of the nose, a minor correction can be used to help align the nose.  If the resultant deviation is due to cartilage in the nose, a more major procedure may be indicated.  In extremely deviated noses, patients may require an additional minor procedure to help the nose look straighter.
3.  Cartilaginous and soft tissue memory of the nose-  The cartilage of the nose has memory and depending on the technique utilized may influence the nose back to the deviated side.  Even in radical reconstructions of the nose, the soft tissue memory of the nose may influence it slightly back to the original deviated side.  

My strongest advice to you is to wait at least 1 year from your initial septo-rhinoplasty surgery before considering revision surgery.  You’ve been patient enough to do that – so good job!   Patients are often surprised at how much change can take place so long after their initial surgery – so much so that revision surgery is sometimes no longer even considered. 

If your problems do persist more than a year after the surgery, certainly revision surgery could be considered.  Multiple revision surgeries, however, should be avoided.  Very careful planning and consideration of your revision procedure should take place before you proceed.  Sometimes, simple steroid injections can improve the apparent larger size, and even the apparent shift to the left, if this is related to scarring of the soft tissue in the nose.  Any revision procedure should involve a very detailed analysis and carefully tailored individualized plan.

There are many possible causes for your dissatisfaction.  Without pictures it is very difficult to comment.  The good news is there is nearly always a reasonable solution.  I would seek out a plastic and reconstructive surgeon with craniofacial training as this is where I developed my technique and skills in treating secondary and tertiary rhinoplasty.  Unfortunately most patients slide down a slippery slope after one unsatisfactory rhinoplasty.  they often visit another surgeon with limited rhinoplasty expertise that does not identify the root problems and actually worsens the situation by removing more and more cartilage.  This is when patients get to the point of 'tertiary rhinoplasty' where rib cartilage is actually needed to recreate aesthetic structure.  Avoid this path by seeking an appropriately trained practitioner with this expertise!

 

 

All the best,

 

Rian A. Maercks M.D.

I'm sorry to hear about your experience.  Unfortunately, you are not alone.  If your original surgeon cannot help you any further, get a copy of the operative report and seek out a Board Certified Surgeon who is a specialist in the face who can help address the problem.  The issues involved are two-fold: 1) underlying anatomy that is contributing to the crooked nose and 2) external aesthetics (tip, uneven nostrils, etc.).  Depending on how much work needs to be done, revision surgery can be challenging.  Please get a personalized consultation from a board certified specialist in facial plastic surgery who can assist you in achieving the results you seek.

It does sound like you need a revision procedure. Time now to take a deep breath, start doing your research and move forward. Deviated noses by themselves are difficult to correct  but adding the revision factor increases the complexity. You need to find a surgeon with skill, experience, interest and comfort at both. Make sure you see plenty of before and after pictures of previous patients he/she has worked on with these problems. Try to sort out in your own mind what is your highest priority-straightening, refining etc. Above all take your time and don't rush your decision. You lose nothing by being patient. Good luck.