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

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!

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

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.