Bad rhinoplasty. What should/can be corrected? (Photo)
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Doctor Answers 4
Bad rhinoplasty, which should be corrected?
From the very limited photographs, it appears that there is a significant hanging columella and a twisted nose. A spreader graft placed underneath the concave upper lateral cartilage is performed along with osteotomies to straighten the crooked nose. Reduction of the hanging columella is performed with a columella-plasty. For more information and many examples of both procedures, please see link and the video below
In order to evaluate more accurately- a good and clear set of before and after photos is needed. From the limited photos that are submitted - it appears that a revision may be indicated to improve your nose in its entirety. Seek an experienced Board Certified PS with a specific interest in Rhinoplasty, wide variety of before and after photos. There is no substitute for experience.
What should be addressed in my revision
The things I see that should be addressed are the following: a hanging columella, nose deviates to the left, and the left ala (nostril) is somewhat collapsed. The tip aesthetics can also be improved. The dorsum (bridge) was also brought down more than ideal. This can sometimes be challenging to correct an can sometimes be left alone if the dorsum/tip can be aligned. Full photos would benefit this analysis. Good luck!
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You appear to have been shortened too much dorsally....this has rotated you up and pulled your tip as well as allowing you to twist and deviate leftward.... in addition to the dorsal shortening forces, your ala are likely retracted secondary to over-resection of your nasal tip cartilages....provided that your skin has remained supple, much of this can be corrected with a revision rhinoplasty complete with structural grafting....this would most likely include bilateral spreader grafting, bilateral lateral crural strut grafting and columellar strut grafting.
The decision to undergo a revision rhinoplasty needs to be considered carefully ..Unfortunately, unsatisfactory results and secondary deformities from primary rhinoplasty are common.... like many other advances in science and technology, the techniques and approaches to rhinoplasty have become significantly refined over the last 20 years..... much of what is done now by qualified rhinoplasty specialists is much more 'constructive' than the 'destructive' methods of the past.... still many patients have suboptimal surgeries that result in asymmetry, over-resection of supporting structures and ultimate collapse over time. There are many true rhinoplasty 'experts'.... now your work begins...unfortunately, many plastic surgeons who hold themselves out as rhinoplasty experts are not...You need a thorough evaluation and a well thought out plan....you will need to gain the confidence that your surgeon has the skills and aesthetic judgment to fix your problem....you will need to see several doctors to become convinced of what an actual expert is...find out who OR nurses and doctors go to and where they send their family/friends .... do your homework and be sure that your revision rhinoplasty surgeon has:
1. many years of rhinoplasty practice experience
2. judgment and techniques that have evolved over time
3. a practice focused on rhinoplasty
4. a willingness to do difficult, secondary and reconstructive cases
5. an interest in teaching others how to evaluate and do rhinoplasty properly
6. a willingness to share rhinoplasty resume, photos and patient experiences with prospective patients
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.