Pinched tip + tight thin skin + nostril asymmetry. Can it be fixed with revision to achieve a natural looking nose? (Photo)

Question

I had rhinoplasty done three years ago. For the first year I was happy with it,cause it looked natural. Once the swelling went down I've developed a pinched tip and right nostril is bigger then the other. Also, my skin is really thin and I have a weird brown patch where the surgeon has rasped the bone. On top of these I think my nostrils have flared as well. I was wondering if it can be fixed with revision in order to achieve a natural looking nose . thank you in advance

John Frodel, MD · Answer

As is well known with rhinoplasty, the skin can contract over the underlying structures for years after the initial surgery.  You indeed appear to have constriction around the tip and over-narrowing in the middle of the roof of the nose.  The flaring of the nostrils is likely relative to the perception of over-narrowing in the tip region.   I recommend that you seed consultation with a surgeon who performs many revision rhinoplasty procedures in order to review your options and goals, as you certainly do not want to have more than 1 more operation, if possible.  Best of luck to you.

William Portuese, MD · Answer

Yes, a revision rhinoplasty procedure can be performed in an attempt to give a more symmetrical nose. The pinched tip can be widened with cartilage grafting techniques and to some degree the nostril asymmetry can be  improved. It's important to obtain operative reports from the first procedure to determine how much cartilage is left on the inside of the nose for grafting purposes. For examples on how we have widened narrow noses, please see  the link and the video below

Richard Galitz, MD, FACS (in memoriam) · Answer

Looking at your photos you have a classic over done looking nose. Almost all the problems can be addressed and corrected with cartilage grafts from the conchal bowl of the ear to the nasal tip. It is very important to stay away from the injured and discolored dorsal nasal skin that was probably harmed by too superficial a dissection originally as any work here could lead to a dissasterous loss of skin.   It may not be realistic to expect perfectly symmetrical nostrils at this stage.    As with all revision surgery like this you must go to a surgeon who has dealt with complex problems and revision surgery in the past. Most regular rhinoplasty surgeons are not experienced in this work nor do they usually want to get involved in correcting someone else's problem.     I have done many of these corrections in the past and would be happy to give you an honest evaluation of what can be accomplished realistically for you

Richard W. Fleming, MD (retired) · Answer

Your pinched tip, which is obvious because of your thin skin, and your asymmetrical flared nostrils can be corrected with revision surgery. Thin skin is wonderful because it enables us to achieve a defined tip but it also can be a curse because any irregularities eventually become obvious as you have seen.

Pinched tip + tight thin skin + nostril asymmetry. Can it be fixed with revision to achieve a natural looking nose? (Photo)

Answers (4)

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