Would filler help with notched nostrils after revision rhinoplasty? (photos)

Question

About 2 years ago, I had a revision rhinoplasty with cartilage grafts to help improve the tip of my nose and nostril retraction. I feel like my nostrils were lowered and improved, but I also think the revision surgery left them notched and uneven. There is also more nostril show on my right side profile. I’m interested in getting injectables and hope they are a viable option, as I do not want to undergo another rhinoplasty

Jason Emer, MD · Answer

Hello and thank you for your question. You have a very difficult problem to fix. It sounds like your biggest concern is your increased nostril show and notched nostrils which developed after your surgery. This is due to alar retraction- this can unfortunately happen as the scarring after rhinoplasty contracts the nasal alae vertically, as in your case. There are certain maneuvers which can be performed during rhinoplasty surgery to prevent such retraction. Your nasal tip also looks slightly over-rotated (upturned) based on the pictures- this can also happen as a result of either your prior surgeries or the subsequent scarring which can shorten the nose if it is not adequately supported. Given your previous rhinoplasty surgeries, and there is no doubt extensive scar tissue present in your tip and alae, fillers would not be able to overcome the scarring, and only an open rhinoplasty can best address all your issues.

In addition to addressing your aesthetic concerns, your septal cartilage (or an off-the-shelf alternative) would be harvested (removed) and turned into multiple cartilage grafts, which would then be secured into different areas of your nose for structural support, including in the columella (middle bottom portion of your nose between your nostrils) to really reinforce the tip and alae, and prevent recurrence of the alar retraction.

The open approach is very effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery. I would only recommend going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible.

Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos and description provided.

Dr. Donald Groves, our expert facial plastic surgeon, has extensive training and experience with complex rhinoplasty surgeries, so I’d recommend for you to come see him (or another plastic surgeon who is extremely comfortable with rhinoplasties) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Emer

Eric M. Joseph, MD · Answer

We have had excellent success lowering nostril margins nonsurgically with microdroplets Silikon 1000 for many years. Sometimes peoples' results can be limited after they receive alar rim cartilage grafts. I believe some amount of permanent improvement could be achieved, however, if your nostril margin is stiff and firm to the touch, your results may be limited. This helps! Sincerely, Dr. Joseph

Ronald J. Edelson, MD · Answer

Your alar is not nearly as notched as some I’ve seen including after my own cases. You can try fillers but I would leave it alone.

David S. Rosenberg, MD · Answer

yes I think fillers can help improve the appearance of your nostrils. You need to be aware that due to having 2 previous rhinoplasties that the blood flow to your nose has been altered making filler injection to the nose more precarious

William Portuese, MD · Answer

We would not recommend fillers placed in the nasal tip because of the risk of skin Necrosis. The hanging columella  present can be  reduced with a columella-plasty and the notched nostrils will require composite skin/ cartilage graft from the ear to bring the notched nostrils back down.

Would filler help with notched nostrils after revision rhinoplasty? (photos)

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