Raising bridge with thin skin?

Question

I'm starting to meet with doctors to discuss revision rhinoplasty. My primary concern is uneven nostrils which seems addressable - which is a relief. My secondary concern however is my bridge which was originally high and slightly concave - now very low. This does not seem fixable from meeting with two doctors. Both advised against it - that any graft would be extremely hard to smooth and look natural because skin is so thin at the bridge. Do you all agree?

Philip S. Schoenfeld, MD, FACS · Answer

You are correct that making your nostrils more even can be accomplished.  I perform a great deal of revision rhinoplasty and an over resected dorsum in a thin skinned individual is challenging but absolutely treatable issue with high patient satisfaction.  A simple onlay graft is probably not going to do the trick but there are several other interventions available specifically used in this circumstance.

Eric M. Joseph, MD · Answer

It would be easier to advise you if you posted photos of your nose with your concerns. In general, microdroplet Silikon-1000 injections maybe considered for both nostril lowering and bridge-raising even in those with thin nasal skin types. An examination would be necessary to determine your candidacy. I hope this is helpful! Sincerely, Dr Joseph

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.For your first concern regarding uneven nostrils, it is possible to make them more symmetrical but please keep in mind that 100% symmetry is not achievable.Regarding your second concern about the bridge, usually it is possible to make it higher with cartilage reconstruction. However, without seeing your face photos I cannot say if it is possible on you or not. If you can provide some photos from front / side / down I would be able to make a better evaluation.
Thank you in advance, have a good day!

Nima Shemirani, MD · Answer

Hi @Practical8751! A low dorsum can be raised using finely diced cartilage. I recommend seeing a revision rhinoplasty specialist for in person examination. There are several options for you that can be determined after examination. Best of Luck, Dr. Nima!

Steven J. Pearlman, MD, FACS · Answer

A low dorsum can be augmented using finely diced cartilage. After the cartilage is reconstituted with tissue glue, called Tisseal, we then cover it with perichodrium from the rib where we got the cartilage graft from. This will yield a higher bridge but still have a smooth dorsum even in patients with thin skin.

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

Hi there! Thanks for your questions. Raising the bridge with thin skin can be done though I agree you have to pay great attention to imperfections which may "show-through" in the future. I often employ temporalis fascia to provide a "buffer" and help smooth the bridge. This does initially create some swelling and a pink-hue over the skin but does contract overtime and helps to provide camouflage. As for grafts, some use rib while others prefer DCF. There are pros and cons to both. Hope this helps!

William Portuese, MD · Answer

Revision rhinoplasty is the most difficult procedure to perform correctly in the entire field of cosmetic surgery, therefore a full set of facial photographs are required to make a determination about how best to proceed. Trying to make nostrils symmetrical is impossible due to the fact that there's a left half of the nose and right half of the nose. There are multiple options upon how to build up a bridge, if necessary. It's important know how much cartilage is left over on the inside of your nose for grafting purposes in addition to a copy of the operative report defined out what maneuvers were performed in the first procedure

Raising bridge with thin skin?

Answers (7)

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