Lateral crural strut graft to restore old nose's appearance? (photos)

Question

Hello, i had a botched rhinoplasty 5 months ago and am considering a revision to restore some of my old nose's appearence. The surgeon took off 5 mm (left) and 6 mm (right) of my lateral cruras, which caused a "pinched" tip with parenthesis deformity and a "s-shape" from the base view, and supra-alar creases that i very much dislike. Does lateral crural grafting can treat all theses problems and restore the old tip shape ? Thank you very much

Alejandro Nogueira, MD · Answer

Yes, you have reasons to seek a well done revision and an enhancement of the poor results.
The amount of lateral crura removed in your case is unknown by you in real and accurate terms, no matter what you are told or have read.
Actually, that is irrelevant somehow; the relevant detail in your case is not the amount but the area of resection; it seems to me absolutely clear on the images which is the cause of your deformity.
During rhinoplasty of those noses with bulbous shape and size there is a massive excess at the upper edge of the lateral cruras of the alar cartilages, therefore we perform a so-called cephalic trimming of the lateral cruras, removing the excess as much as to refine the tip (considering gender and ethnicity issues) but not removing too much so as to induce a fake look, a pinched effect or an overly rotated tip.
Besides the caution not to remove too much / too little cephalic lateral cruras... there is another MAIN caution: never ever and under no circumstance against all odds, temptations or reasons... NEVER REMOVE OR WEAKEN THE TAIL OF THE LATERAL CRURA; by doing so the surgeon creates a sunken and pinched look and a functional collapse when breathing in. E.g.: your nose.
It is clear your surgeon did not remove any cartilage excess from your boxy tip and the portions of cartilage which indeed shoudl be trimmed away, did not carry out any tip plasty, reshaping or resizing, but to the contrary indeed performed a resection of the functional tail of the lateral cruras, leading to the afore mentioned and image-visible deformities.
The solution is grafting... but not batten grafts but REPLACEMENT grafts to restore the continuous arc of the crura which is missing now. Needless to say the rest of your case's issues have to be addressed:
-boxy square tip
-upturned tip (piggy)
-high osteotomies, visible at the walls
-caudal septum trimming and lack of tip support
-partial inverted V deformity
Yours is a 8 out of 10 scale of difficulty in revision rhinoplasties, surgical time 4-5 hours; you need a real expert in complex revisions who would re-structure and restor nasal support and provide beauty.
If you wish better grounded opinion please do post or send privately well lit, focused and standard images: frontal, both lateral and both oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

Lateral crural strut graft to restore old nose's appearance? (photos)

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Lateral crural strut graft to restore old nose's appearance? (photos)

Answers (1)

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Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.