Dented Nose After Rhinoplasty?

I know that sounds complicated, but as the field of rhinoplasty continues to evolve, we recognize more and more conditions that can predispose patients to abnormal dents after rhinoplasty. One such case is called a "parentheses" deformity. This is when the tip cartilages are angled upward before surgery. Even removing a small amount of cartilage can cause dents and this deformity. This condition can be fixed (or prevented in the first place if recognized) by small grafts of your own cartilage to give more support to the nasal tip cartilages.

Unfortunately, rhinoplasty is a procedure that is associated with a fairly high rate of dissatisfaction. There is a high incidence of patients requesting revision surgery. One of the more difficult things to achieve with rhinoplasty is a perfectly straight nose. Nevertheless, with attention to detail and good techniques, skilled rhinoplasty surgeons can achieve a straight look.

Oftentimes irregularities as well as indentations following rhinoplasty can correct themselves with time. Revision surgery should not be considered until a patient is a full year out. Sometimes small indentations are due to dermal adhesions and with time and occasionally massage they will resolve themselves. Small irregularities that persist at the one-year point can sometimes be addressed intradermally with filler injections which can be done in the office. For those patients, however, who have more significant deformities, revision rhinoplasty has to be considered.

When considering revision rhinoplasty, it is important to go to a surgeon who regularly performs not only rhinoplasty but revision surgery. Revision rhinoplasty presents challenges greater than initial rhinoplasty and should be approached with caution. The first step in planning a revision of rhinoplasty is to consult with a Board Certified facial plastic surgeon who regularly performs nasal surgery.

Hi Crooked,

It appears that the alar rims of your nose are slightly notched.  This can be corrected with cartilage grafts during a revision rhinoplasty.  Whether you need it or not depends on how much it bothers you.  Good luck and be well.

Dr. P

This is a very personal decision.  I would suggest you meet with an experienced rhinoplasty surgeon to discuss your concerns and to have him tell you what can be realistically accomplished.  Personally, I always discuss with my patients post surgery if any further steps can be taken to further improve results, provided the patient is interested.

It's hard to tell exactly which spot is bothering you. It does appear that you have a demarcation to the tip and nostrils rather than a smooth transition. This can be fixed if it is of concern. Overall though is what you have now better then what you started with/

You have one of the most common problems following rhinoplasty.  When any surgeon removes a bump, even one as thin as 2 mm, that action opens the intact cartilaginous arch that forms the lower half of the bump.  Once the "roof" is gone, there is nothing to hold the sides out, so they fall toward the mid-line, producing hollows or dents on each side.  If the septum is't in the middle (deviated), the nose can look newly crooked; fortunately, yours doesn't.

Often the airway narrows as this external narrowing of the sides occurs.  If breathing was normal before surgery, patients can be unhappy.  The surgical treatment is to place cartilage grafts under the lining on each side  These grafts will fix the dents and  (according to my published airflow research), double airflow.  These grafts can be placed at the primary surgery to prevent the problem.

You can use temporary camouflaging fillers also without improving your breathing.

Your friends don't see your nose when they look in the mirror everyday. If dents bother you they can be filled with small cartilage grafts or a filler such as Radiesse.

It is difficult to assess where exactly you feel your nose is 'dented' from this photo. If you mean the distinction between the tip of the nose and the lobule (side of the nose where your nostril is located) then this is a normal occurence in noses that have tip definition or defining surgery.  It could just be something you are not use to having and will take some time for you to adjust to. 

It is difficult to say if you have tip assymetry since the right side has a shadow and the right lobule isn't visible.  If you do have tip assymetry and this is the 'dented' area you mean then you should speak to your surgeon and ask if that can be corrected or not.  Maybe it can but then maybe it can't be corrected.  Your surgeon should be able to explain and make a recommendation.