How to Decrease Indentation and High Nostril Crease After 1st Rhinoplasty

Hi, Suay.

Have any local surgeons suggested trying a filling injection? It would be a low-risk solution.

My colleagues are correct in stating that if you have a breathing problem surgery is needed. However, if the matter is one of appearance, check out the possibility of plumping that somewhat pinched area witha filler.

-Robert Kotler, MD, FACS

Beverly Hills, CA

If you are having breathing issues as well as the pinching, it would probably be best to correct those areas with a sturdy cartilage graft to prevent further collapse. Smaller areas can be corrected with fillers or crushed cartilage if support is not needed. You need to see a rhinoplasty expert in your area to better address this problem.

The most common cause of a pinched tip  (what some patients call a "sausage nose") after rhinoplasty is contraction of the skin and soft-tissue envelope of the nose without adequate support of the lower lateral cartilages. In your case, it appears that perhaps the lateral crura of these tip cartilages were too weak or flimsy to support this contraction process. This issue can be corrected in revision rhinoplasty by placing lateral crural strut grafts. These grafts are ideally harvested from your septum (but in some cases from the ear or rib) and sutured underneath the lateral crura to support and strengthen them. When performed by a revision rhinoplasty specialist, this technique should restore a more natural, unoperated appearance to your nose and may improve your ability to breathe. The tip of your nose shouldn't look any bigger or wider and may, in a sense, look less prominent because it blends in better with the rest of your face. Hope this answers your question.

Regards,

Umang Mehta, MD