Is it possible to fix my nose or do a preservation rhinoplasty? (Photo)

Question

I had my nose done by a surgeon who didn't know what he was doing when I was 17. As the years went by it continued to change and I have recently started noticing that it's start to look completely different. I would like to see if it's possible to fix it. I was told I had an inverted v, open room deformity. I have posted some before photos at the end. My current photos are at the beginning.

Eric M. Joseph, MD · Answer

I know by your narrative that you're looking to 'fix' your nose, however, it's not clear precisely what you are looking to achieve. Based on your photos, you appear to have a somewhat low bridge on profile with an exaggerated curve. If you are looking to achieve a straighter nasal profile appearance, depending on your examination, microdroplet Silikon-1000 injections may be considered for a non-surgical and permanent result. I hope this is helpful! Sincerely, Dr Joseph

Steven M. Denenberg, MD · Answer

You do appear to have an open roof deformity, and in fact the bridge is wide-ish all along the nose down to the tip. One of the features that I notice most is that the tip seems prominent. It sits low, and I'd like to see it elevated. It's a bit wide, and it stands out beyond the position of the bridge just above it. So to my eye, some significant work on the tip would be even much more beneficial than narrowing the bridge.

The good news is that these changes are a hit list of the changes that are most predictable to make in a rhinoplasty, even a revision, in expert hands.

How *much* to elevate or narrow the tip, or narrow the bridge, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Philip S. Schoenfeld, MD, FACS · Answer

From the photos that you have provided I suspect that you had a hump reduction and a fairly bulbous tip at the time of your original rhinoplasty surgery.  In cases such as this, you would need a revision rhinoplasty to address the dorsum (bridge) or the nasal tip or both.  Preservation rhinoplasty is a technique that really does not apply to your particular situation.  You need dorsal augmentation, perhaps spreader grafts and likely alar rim or articulated alar rim grafts.  The question would be if you still have septal cartilage or would you need cartilagenous rib grafts.

William Portuese, MD · Answer

Revision rhinoplasty is more difficult than a primary rhinoplasty, and one of the most difficult procedures to perform in the entire field of cosmetic surgery. You need to be very specific on what your goals are trying to improve your nose. It is important to know how much cartilage is left over on the inside of your nose for potential grafting purposes if you're trying to build up the bridge. Preservation rhinoplasty is not applicable in your case.

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