Three years post rhinoplasty. Prominent ridge along left side of nose - is this a step - off deformity? (Photos)

Question

I had a rhinoplasty procedure three years ago. Over time, the “ridge” along the left side of my nose has become more prominent. Is this a step-off deformity along the osteotomy line? What can be done to correct it?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you may benefit from a revision rhinoplasty. The dorsal aesthetic lines can be improved with placement of spreader grafts and the tip symmetry can be improved with placement of a mastoid fascia tip graft. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Alejandro Nogueira, MD · Answer

A bit of historical background; around the early years of XXth century (first decade, 120 yrs ago), Dr. Joseph a brilliant genius of surgery invented in Germany the basics of rhinoplasty as it is done today, and his disciples together with himself designed the toolkit still in use by contemporary surgeons.

Well, Dr. Joseph defined the "Joseph's angle" as the location where osteotomies SHOULD be done in all cases, so that the closure of the roof is efficient and the osteotomy itself is invisible. Well, back-to-school-time surgeons fail to master this A-B-C obligation of practice or either ignore it because they are afraid of breaking the wrong bone (unguis, malar, ethmoid).

When the osteotomy is made too high (close to the nasal bridge) it becomes visible and in skinny patients terribly visible, hence your situation.

There are other additional wrongdoings, like the left nasal bone was not fractured en-bloc and it is sunken, there are ridges on the bridge, the upper bridge suffers open-roof deformity, there is inverted V deformity at the middle vault which is also pinched due to its collapse, etc, and IMO the worst: your biphid, boxy tip with verticalized lateral cruras and alar rim retraction are untoched.

I strongly recommend you seek the help of a relible, experienced, meticulous and solvent revision rhinoplasty surgeon.

Bottom line: due to your skin transparencies you might need DEEP temporal fascial masking of the entire nose to hide the step-offs and other irregularities, pluse hiding the several grafting of structure rhinoplasty you need now.

Steven M. Denenberg, MD · Answer

The bone in that area typically isn't nearly that wide (the part that *wasn't* moved inward in the rhinoplasty). Also, the "ridge" seems to extend all the way up to the side of your eye. I'm suspicious that it's a prominent vein. Can you compress it?
It does look as though things were quite enthusiastically narrowed in your operation. The bones are narrow, and the cartilage of your bridge above the tip is very narrow. What's the profile look like? Especially if the nose still looks a bit long, you might consider narrowing and elevating the tip, and making the mid-part of the bridge a little wider so it's more uniform to the rest of the nose?
But I'm digressing from your original question. Press the prominent ridge very softly with something small, like the point of a pencil -- see whether it compresses.

Three years post rhinoplasty. Prominent ridge along left side of nose - is this a step - off deformity? (Photos)

Answers (3)

Recommended reading

Everything you need to know about Revision Rhinoplasty

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

Three years post rhinoplasty. Prominent ridge along left side of nose - is this a step - off deformity? (Photos)

Answers (3)

Browse related questions

Recommended reading

Everything you need to know about Revision Rhinoplasty

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