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

Hi. Thank you for sharing the photos. You really need to be examined to give you an accurate diagnosis. However, this could be due to positioning the lateral wall osteotomy or fracture during the rhinoplasty at a higher position than expected, leaving you with a septal deformity. Given that it has been 3 years and the issue remains unresolved, it is unlikely to resolve on its own. And if this is truly bony in nature, your only option would be a surgical approach and revision. If this is your only concern, it may be possible to manage with a limited revision.

We have had very good experience feeling in divots and irregularities along somebody's nasal sidewall, when there are visible irregularities after previous rhinoplasty surgery. For the last 26 years, we have been advocating the use of Silikon-1000, for permanent results. I hope this helps! Sincerely, Dr Joseph

That's very unusual! I'm curious what it feels like. It's possible that the bone collapsed in on the left side of the nose but someone would know better if they can feel it. If that's what it is, to correct it you'd have to get the bone popped back out again.

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

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.

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.

What you’re describing sounds consistent with a step-off deformity along the osteotomy line, likely from a osteotomy performed a little higher, which can appear as a ridge over time. The solution is surgical — typically smoothing the area with a rasp or performing a limited revision with repeat osteotomies to restore a straight contour. This is a predictable correction in experienced hands and doesn’t always require a full revision rhinoplasty.