Left with a Crease and Dent on Side of my Nose After Revision, Ive Had 4 2nd Opinions and No One Knows How to Fix It! (photo)

I read your concern and reviewed your photo which is blurry:

I can't tell if the indentation your referring to is your deep supra-alar crease, or another issue along the right side of your lower bridge. Since you have had 4 nasal surgeries, you should leave any further surgery to your nose as a last resort. In my practice, nasal indentations may be filled with Silikon-1000, an off-label filler for permanent results.

I hope this is helpful for you.

Dr. Joseph

Difficult to say from this photo. Most depressions can be filled with cartilage grafts. You may want to consider a trial with some filler before having further surgery. If you like it then you can proceed with a more permanent solution. If you have skin atrophy this is more dificult and a dermal or fascia graft may be necessary.

Sorry to hear about your experience.  It is hard to say based on the photo you provided but generally dents in the nose can be improved.  As far as the pinched appearance, it depends on what was performed to the underlying anatomical structures.  Please consult with a board certified specialist who can best address your concerns.

It's difficult to see from a single photo but indentations, from Rhinoplasty and Revision Rhinoplasty are only caused by three things, IMHO.


An unven dent occurs from cartilage removal or dissolution.  The more Rhinoplasties you have the more tissue, including cartilage is removed. 

Removal of subcutaneous scar tissue can sometimes cause temorary indentations.

If all the tissues between the outer nasal skin and the inner mucosa have been removed, these two layers fuse together and create a relative indentation.


The red coloration of the skin makes number 3 above more likely and does not bode well for further Revision Rhinoplasty Surgery.  If you have already had 3 or 4 consultations, I suspect you may already have heard the answer which may have been "don't do any further nasal surgery".  You mifght try some fillers to the area  once everything has settled down and healed.

Overall, your nasal profile is very nice, although I would have preferred to see a very slight rotation upward of the very tip of the nose. Fillers such as Juvaderm or Radiesse can be used to fill in the depresssions, and if pleased, you may select  a permanent solution with silicon gel. I do not see a cause for another revision surgery, but to be fair, you must be evaluated by an experienced nasal surgeon before you do anything. Laser treatment can also help remove any small reddish discoloratiion I see in the picture  I hope this explanation was helpful.

Without an examination it is difficult to determine if your dent and crease are secondary to a problem with your skin and/or the underlying cartilage. I'm sorry you're having difficulty establishing a diagnosis, but it will be necessary to seek another consultation.

Hi,

It looks like you may have lost cartilage under that area of the skin as well as some atrophy of the skin. Cartilage can be added to elevate the depression but dealing with the skin atrophy will be a little more difficult. Depending on what if looks like in person, you may need to have a local flap if indicated. However, it's possible that the skin atrophy is untreatable.

Best,

Dr.S.