Can anyone tell me how this was fixed so I know what to ask for? (Photos)

Question

This man has the EXACT same nose as me, this is the before and after. I want to just improve my nose like this man has but a surgeon i saw seem to think only a complete reworking was possible. I'm a woman and have never had surgery on my nose before. attached are the man's nose and my nose.

Ruslan Zhuravsky, DO · Answer

Hi, great question. What you're seeing is a collapse of the "lateral crus" of the "lower lateral cartilages". The reason people may have asked if you had previous surgery is because we see this often as a result of careless rhinoplasty, where these cartilages are over trimmed. This does obvioulsy occur naturally sometimes as well, to different degrees. There's a much longer detailed explanation but to answer you're question, the main technique is called Batten grafts ... they give support to that indented region, and create a smoother transition from tip to Ala. In cases like this I also like to add support with an alar rim graft, which helps support the nostril rim, preventing it from retracting so much. The cartilage used for these comes from the septum. This level of rhinoplasty should only be done by someone specializing specifically in rhinoplasty. Im adding a link to one of my own patients that had this naturally occurring indentation, but without as much nostril retraction. I have some others but they are not on the site so unable to share unfortunately. You'll also see this on some revision surgeries. Hope this helps! Good luck!

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have a crooked nasal appearance and a pinched nasal tip appearance. We can see by the example you posted that you would like to have your tip raised. You may also benefit from nasal straightening as well, which would likely necessitate cartilage grafting, for a less droopy and less distracting nasal appearance. It's best to explain to your rhinoplasty specialist what is bothering you, and then computer Imaging may be used to establish goals. That is always a good time to ask the surgeon how he plans to execute the surgery. Wishing you well moving forward. Sincerely, Dr Joseph

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photograph.

In the photograph that you have shared, it appears that your nasal skin is very delicate and shows all the shape of the cartilages underneath.

To begin with, unless the images of the gentleman that you have shown is reference were taken at approximately 2 years from surgery, you may be evaluating the smoothness of the contours as success of surgery but it could also be temporary swelling.

If you would like to do something very conservative for the shape of your nose, injectable filler treatment can lead to softer contours by building up in the areas of depressions.

The advice that you had from the rhinoplasty surgeon is in my opinion correct because it is not technically possible to do an elegant surgical masking of the contour irregularities in particular since the nasal bridge also shows some irregularities and slight deviation.

For success in producing a more symmetric contour through surgery, full rhinoplasty appears to be the sensible option whether using an open or closed approach.

Surgical techniques that help to create smoother contour is for the nose also include using biological implants. They would however increase the width of the nasal tip and bridge more significantly and the end result may seem to be too wide for your liking.

Caner Kacmaz, MD · Answer

Hi! This is Arzu from Dr. Caner Kacmaz Clinic.  with piezo rhinoplasty we can reshape your nose and nostrils. For more information please do not hasitate to contact with us.
Kind regards

Oakley Smith, MD, FRCSC · Answer

Hi, rhinoplasty can enhance nasal profile regardless of the shape.
It is better for you to consult with a facial plastic surgeon who can examine you and discuss the surgical procedure and the post op recovery 
process.

Gary M. Horndeski, MD · Answer

You will need an open rhinoplasty.  The cartilage will have to be repositioned to refine your tip and elevate it as well.

Best Wishes,

Gary Horndeski, M.D.

Lexie Wang, MD · Answer

Based on these photos alone, it looks like primarily the tip/columella need to be lifted and supported, possibly also removing some alar flaring too. I'm not sure what you mean by "complete reworking" but this is going to be more involved than a "small" rhinoplasty if that's what you mean?

Ronald J. Edelson, MD · Answer

The only thing I can tell you about the woman photo is that appears that she had a rhinoplasty before but was left too long. Also the nostrils flare a lot which can be treated with alar excisions

Mats Hagstrom, MD (license on probation) · Answer

It sounds like you’re trying to understand rhinoplasty surgery without having had in person consultations with plastic surgeons.
In the reference picture you’ve included it’s difficult to know which is the Before and, which is the after picture. Typically before pictures are viewed on the left and after pictures are viewed on the right. In your example, it looks reversed.
If that’s the case, and the left side of the picture is the after picture and it looks like he had in fracturing. The pictures are incomplete to make a quality assessment. To make an assessment for rhinoplasty surgery. We need a complete set of facial pictures from all angles.
Rhinoplasty surgery is not any one operation. The term simply means to reshape the nose. Under the umbrella of rhinoplasty surgery are many different individual small procedures to treat different aspects of the nose. The nose is usually divided into subunits, and each subunit has different potential operations that can be applied. To get an assessment and better understanding of what surgery can, and cannot accomplish. I suggest scheduling a multiple in person, consultation with local board-certified plastic surgeons, who have a proven track record with rhinoplasty surgery. 
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of the previous patient who had similar nasal characteristics to your own. The surgeon should describe each sub component of the rhinoplasty surgery they recommend. I suggest you take notes during the consultation, so you have a good understanding of exactly what procedures they recommend applying. 
Rhinoplasty surgery is fairly complex and this is a procedure. Patient should seek out at someone who has substantial skill and experience with a proven track record.
This may require scheduling multiple consultations.
Best,
Mats Hagstrom, MD

Can anyone tell me how this was fixed so I know what to ask for? (Photos)

Answers (9)

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