Could non-surgical rhinoplasty revision fix my concerns? (Photos)

Question

Around 2 and a half years ago I had open rhinoplasty to remove a hump on my bridge and reduce nose protrusion. While still pleased with the outcome, my nose is now noticeably asymmetric. On one side of the bridge there is too much scar tissue, and on the other side, my tip it looks like it 'drops'. Could steroid injection reduce the scar tissue on my bridge, and could a filler improve the appearance of my tip?

Jason Emer, MD · Answer

Hello and thank you for your question. You have a tricky problem to fix- and it is very difficult to fully see what's going on based on the pictures provided. It sounds like your biggest concern is you'd like to alter the dorsum and tip after a prior rhinoplasty, as you mentioned. The asymmetry could be due to either the underlying structure during your initial rhinoplasty, or could be due to the contractile/distorting forces of scarring after rhinoplasty, which can unfortunately happen after any surgery, but is particularly devastating and noticeable after rhinoplasty. There are actually certain maneuvers which can be performed during rhinoplasty surgery to prevent such retraction and distortion to minimize the likelihood of asymmetries, but the majority of surgeons either are not aware of these maneuvers or do not perform them. Given you've previously had a rhinoplasty, and there is no doubt extensive scar tissue present throughout your nasal dorsum and in your tip, so fillers would not be able to adequately overcome the scarring in a satisfactory manner, and only an open rhinoplasty can best address your issue.

In addition to addressing your aesthetic concerns, your septal cartilage (or an off-the-shelf alternative) would be harvested (removed) and turned into multiple cartilage grafts, which would then be secured into different areas of your nose for structural support, including in the columella (middle bottom portion of your nose between your nostrils) to really reinforce the tip and alae, and prevent distortion and asymmetries from re-forming. As you've already had a rhinoplasty, likely your septal cartilage has been used already, so we'd use an off the shelf alternative (MTF cartilage).

The open approach is very effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery. I would only recommend going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible.

Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos and description provided.

Dr. Donald Groves, our expert facial plastic surgeon, has extensive training and experience with complex rhinoplasty surgeries, so I’d recommend for you to come see him (or another plastic surgeon who is extremely comfortable with rhinoplasties) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Emer

Eric M. Joseph, MD · Answer

Based on your photos, you may have a polybeak deformity. This is when the bottom of the bridge of your nose protrudes a bit further than your nasal tip. If this is associated with a droopy nasal tip appearance, I'm afraid revision rhinoplasty may be the best option for you. Please consult with several reputable rhinoplasty specialists who offer computer Imaging so you can get sound advice. I hope this is helpful! Sincerely, Dr Joseph

Oakley Smith, MD, FRCSC · Answer

Hello,
Liquid rhinoplasty with filler can improve the irregularities on the bridge of the nose. It is better to consult a facial plastic surgeon who can examine you and discuss the option of liquid rhinoplasty.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Absolutely, those would be two options. For the scar tissue, steroid injections would be needed roughly every 3-4 weeks until the response is achieved. Additionally, my patients will compress the area and tape nightly. Filler can then be used to fill in the tip area. You are correct on what you thought! Hope this helps.

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