My nose collapsed after primary nose surgery. Any suggestions? (photos)

It appears to me that you have an "inverted V deformity" with middle nasal vault collapse. This means that the cartilages in the middle third of your nose are collapsing off of the bridge and nasal bones downward into your nose. I do believe that cartilage grafting with spreader grafts is the mainstay of therapy for this problem. It's not just the actual grafting of the cartilage, but the act of resuspending the collapsed cartilages (along with the new spreader grafts) upward and outward back to the nasal dorsum. I agree that you also suffer from a "pollybeak" deformity from over-resection of the nasal bones and/or under-resection of the dorsal cartilages. You may need more cartilage placed onto the upper third of the nose, a bit more taken down from the middle third, or a combination of both (likely in your case). While full healing isn't reached until at least a year after your initial surgery, 6 months is a reasonable amount of time to begin considering the revision since the defects are obvious. I would be leery of injections into the nose since it is a temporary fix, the nasal skin may be very thin,  and since this is a revision and the blood supply is compromised which could lead to an adverse outcome.

You don't need spreader grafts, in spite their "trendy popularity" over the last 15 years... they have very rare and seldom real indications, surgeons and patients do attribute to them varied, bizarre and awesome magic properties, seems when nobody or someone has no idea what to do with a secondary rhinoplasty the first thought in mind is "oh yeah, a spreader graft will work the stuff, and if not at least sounds very cool and professional, the patient will be impressed".This is my comment:-you have over resection of tip support and caudal septum-supratip prominence deformity (aka polly beak deformity)-moderate over resection of dorsum (aka saddle nose deformity)-little work on your boxy tip, barely touchedYou need a very good revision rhinoplasty surgeon to carry out full rebuild with:-cartilage grafts to obtain support of tip and nasal lenght-dorsal grafts-work on the tip-probably or optionally new osteotomiesDo a good search for the right profesional.

You need to wait another three months for a revision of your collapsed nose. At that time you will need soft tissue and cartilage graft placed in the mid nose as well as spreader graphs possible removal of cartilage in the supratip. In addition you may need alarbatten graphs and further excision of cartilage in the tip which I will know when i examine your nose. You can look at various websites under revision rhinoplasty and choose a very experienced revision rhinoplasty surgeon who does natural looking noses. Meet with patients who had a revision and is like yours to determine who should do your nose. You will not need rib cartilage. 

In reviewing your pictures, you appear to have some issues with you nose.  The middle part of the nose appears to be narrow and may has some collapse.  From the profile, you have some concerns about a dip.  It is difficult to give you specifics about what you need without clear communication of your goals and concerns and I would need to review the following:1)  You preoperative pictures2)  Your operative report--The document describing the techniques your surgeon used. 3)  Detail physical exam of your nose to feel it strength and review the 3D structure of your noseGenerally speaking, you need to re-support the middle area of the nose where you have collapse.  This is commonly resupported with spreader grafts.  My gut would think you are going to need spreader grafts on both sides of your nose.  The timing of a revision rhinoplasty is important. Before
undergoing a revision rhinoplasty, the nose has to have time to completely heal
and allow for swelling to resolve. The final appearance of the nose will not appear for 1 year.  For this reason, it is difficult to create the best operative plan until the nose is healed.  I recommend patients waiting at least
one year after a rhinoplasty before undergoing an major revision surgery.
If there is a small irregularity or fine touch up, then it may be an
option to do it earlier. In your case, you are considering undergoing a major
revision rhinoplasty. For
this reason, I would wait until all of your swelling as resolved.

Hello Lina85,Thanks for your question.When you are ready for your revision surgery, I think that spreader grafts will be necessary.  You have an inverted V deformity indicating middle vault collapse and narrowing. Additionally it seems as if your tip has rotated up a bit to much, shortening your nose projection.  In these situations, I am a big fan of bilateral extended spreader grafts.  They help widen and support the narrowed middle vault, and they can help rotate the tip back down into a better position.  As far as bone asymmetries are concerned, most people have them before surgery because of craniofacial asymmetries around the nose.  Asymmetric osteotomies can be used to help get the symmetry closer but not perfect.I would recommend that you speak with a revision rhinoplasty specialist in your area to get a second opinion about maneuvers that would be useful in your situation.Good luck,Dr. Shah

Dear Lina85,Based on your limited photograph, it appears you have a middle vault
collapse. This typically occurs when
there is an over resection of a bony hump.
Without underlying support you also may have a poly beak deformity which usually coincides with the collapse and a weak tip support. I suggest that you seek a board certified facial
plastic surgeon to correct this. Some of
the options include bilateral spreader grafts, strengthen tip support, and also
possibly resecting some of the scar tissues that may have accumulated in the
tip region. Good luck to you.

You will need additional surgery, but it is still too early. I would not opt for spreader grafts, but rather, a combination of cartilage and perhaps fat grafts. In some situations, soft tissue fillers can be helpful, I believe you need more than that.

It appears from the photos you have what is called an inverted V deformity after primary rhinoplasty.  This likely due from the cartilages along the sides of your nose (upper lateral cartilages) falling in.  In these revision cases, ideally one would use septal cartilage to help re-support and suspend the upper lateral cartilages onto the septum.  If septal cartilage is not sufficient then ear cartilage can be used.  These are recommendations based on the photos you have submitted but it is best to see your surgeon or a surgeon in your area that specializes in revision rhinoplasty. 

Before additional revision surgery try fillers to elevate and straighten your nose. If the result appears acceptable than you could consider revision... 

From the photos that you submitted, it does appear that you have what is considered a middle vault collapse that is pronounced on the left side. The treatment for this is a spreader graft. In certain circumstances, a unilateral spreader graft is appropriate if the contralateral side has adequate support. Without examining your nose, it is difficult to tell if you would need bilateral spreader grafts. The dip in your profile will likely require an onlay graft to augment your nasal dorsum or nasal bridge. Best of luck.