What deformities are present? Want to have smooth dorsal aesthetic lines and nice proportions. (photos)

Question

I am seeking a revision rhinoplasty and want just to have smooth dorsal aesthetic lines and nice proportions. What needs to be done operatively to achieve a nice result? It has been 8 years since my primary.

Gary Linkov, MD · Answer

Revision rhinoplasty requires exceptional skill on behalf of the surgeon and great communication with the patient about realistic goals and expectations.
Common cosmetic concerns include a dorsal hump, wide nose, sunken nose, irregularities, and asymmetries. Functional concerns include difficulty breathing through the nose, which can and should be addressed at the same time as your rhinoplasty.
In a revision rhinoplasty, cartilage from your septum may have been depleted and therefore often an alternative source of cartilage is needed, such as from the ear. This is just one of the important differences between primary and revision rhinoplasty that need to be discussed in detail before you decide to proceed with surgery. 
In your situation, there is some degree of midvault collapse. It can be improved with cartilage grafting and dorsal refinement. 
Make sure to seek out the care of a board certified surgeon with extensive experience in revision rhinoplasty. Find someone you connect with, who will listen to your concerns and provide you with a framework for what is possible.  
Gary Linkov, MD
Rhinoplasty Specialist
Manhattan

Nima Shemirani, MD · Answer

Hi @WTrigleth. Thank you for sharing your photos. I recommend seeing an expert revision rhinoplasty specialist for an in person examination. There are several options for you that can be determined after examination.

Best of luck,

Dr. Nima

Best of luck,

Dr. Nima

Christian L. Stallworth, MD · Answer

Thanks for your question.  Based on your photos -1.  On your frontal view, you can see that the nasal bones remain wider and the middle third more narrow.  This results in something called an "inverted-V deformity".  This can be remedied with placement of bilateral spreader grafts and revision of your osteotomies.2.  In addition to the above, your profile is not straight due to slight excess (under-reduction) of your nasal bones, slight over reduction of your middle third, and persistence of excess cartilage and/or scar tissue in the supra tip.  Lowering the bone and supra tip can help achieve a smoother.Please revisit your concerns with your original surgeon.  If this is not an option, seek out board certified facial plastic surgeons with strong experience in revision rhinoplasty surgery.Best wishes.

William Portuese, MD · Answer

The photographs demonstrate wide nasal bones, inverted and concave upper-level cartilages in the midportion of the nose and a residual dorsal hump. A closed revision rhinoplasty can accomplish narrowing the nasal bones with osteotomies, insertion of cartilage spreader grafts to widen the upper lateral cartilages  which will improve the dorsal aesthetic lines. The dorsal hump can be shaved down as well. Revision rhinoplasty is a very complicated surgery, so it's important  to choose your surgeon wisely based on extensive experience.

What deformities are present? Want to have smooth dorsal aesthetic lines and nice proportions. (photos)

Answers (4)

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