Dent in nose after surgery. Should I go for revision with another surgeon? (Photo)

Question

I know it’s still a bit early but I just don’t think this will change. I got a septorhinoplasty back in April and it looks like there is a dent in my nose. I went to go see my surgeon for a follow up band he said it happened because the cartilage in my nose did not heal properly and turned into mush. I really want to believe him and go back in a year for the revision but at the same time I am a bit nervous and am thinking maybe I should look for another surgeon. What are you alls thoughts?

Steven M. Denenberg, MD · Answer

I've never heard of cartilage turning to mush after surgery, but from these limited photos, it does seem like you have something going on that could be improved. Really, though, if the photos were from all angles and showed your entire face and nose, that helps in figuring out from photos what most likely happened and what can be done to improve it. For example, how deep is the dent? It appears that above the dent there is a prominence of the bridge. If that prominence were lowered, perhaps the dent would seem less, and less would have to be done to "fix" the dent. Also, if there's a problem there, and if you are considering a revision, it's important to look at the entire nose to see whether there are other features to address at the same time: is the tip high enough, narrow enough, close enough to the face, issues like that. If you have a revision, typically it's the time to touch on *anything* that's bothering you.
How *much* to lower a prominence, or raise a dent, 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

The issues that you’re having with the appearance of your nose  is not an uncommon one. If you had a hump reduced from the dorsum of your nose then the upper lateral cartilages need to be stabilized to the nasal dorsum to prevent inward collapse of the cartilages. We referred to this as an inverted V deformity. The solution to this particular problem would be bilateral spreader graphs, which is not terribly complicated, but the source of Cartilage might be a little bit of an issue from the use of Cartilage during your previous surgery.

Eric M. Joseph, MD · Answer

Up close photos of your nose are a difficult to interpret, however, and indentation is visible along with thin nasal skin. Depending on your examination, microdroplet Silikon-1000 injections maybe considered for adding volume to your nose and for filling the indentation permanently. I hope this is helpful! Sincerely, Dr Joseph

Jacob Tower, MD · Answer

Hello, hope you are well. It appears that there is a step-off between your nasal bones and cartilaginous dorsum causing the 'dent.' Indeed, the only way to repair this is with revision rhinoplasty. When you proceed with revision, it is very important that you feel confident with your surgeon. Technical abilities aside, if the trust is not there it may be wise to seek a second opinion. You can ask questions like what steps will be taken to correct the area, what the expectations are for revision, and if they have results they can share from similar revisions in the past. Good luck!
Best,Dr. Tower

William Portuese, MD · Answer

It's important to wait at least one year before embarking on another surgery. A full set of facial photographs from all angles are required to make a determination about how best to proceed, since you've only posted one angle, and the nose is a three-dimensional structure. Also important to know how much cartilage is left over on the inside of your nose, since you may need a cartilage graft in that depressed area. Best to obtain a copy of the operative report find out how much cartilage is still left over on the inside of your nose for grafting purposes

Dent in nose after surgery. Should I go for revision with another surgeon? (Photo)

Answers (5)

Answer: Revision Rhinoplasty

Answer: Revision Rhinoplasty

Answer: Dent in the nose after surgery. should I go for a revision

Answer: Dent in the nose after surgery. should I go for a revision

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Everything you need to know about Revision Rhinoplasty

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Dent in nose after surgery. Should I go for revision with another surgeon? (Photo)

Answers (5)

Answer: Revision Rhinoplasty

Answer: Revision Rhinoplasty

Answer: Dent in the nose after surgery. should I go for a revision

Answer: Dent in the nose after surgery. should I go for a revision

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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.