Tertiary rhinoplasty revision. - Am I a good candidate? (photos)

Click on the "Web reference" link, just below my response, or go here:

FacialSurgery.com/RealSelf/RealSelf_gidget88.html



I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.

Mostly, I elevated the tip of the nose. I think it could be elevated even more than I illustrated, depending on your preferences. The woman in the short video above had her nose shortened in a revision rhinoplasty.I don't think that your bridge was over-resected at all. In fact, if you look at the animation, you'll see that I lowered your bridge a bit from its current position.

I'd love to hear what you think of the morph.



You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.





Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.



In your case in particular, you need a surgeon who can get that tip high enough. It'd be a shame to go through another operation and be disappointed that the nose is still too long.

As others have noted, revision rhinoplasty is always a difficult operation. That said, your concerns about the tip are quite valid and generally such problems can be addressed with revision surgery. Depending on your specific anatomy (which requires feeling the nose as well as examining the inside of the nose), there are several techniques to elevate and refine the tip. Of course, this requires an in-office consultation with a surgeon with specific expertise in revision rhinoplasty. It can also be very helpful to bring a copy of your previous operative notes to the consultation. Depending on the record retention laws of your state, though, you may not be able to get records from a decade ago. But you can always try.Hope this is helpful,--DCPPearson Facial Plastic Surgery®

Your current nasal appearance is improved. Your currently droopy nasal tip may also be improved, depending on your examination and what was performed during your last two surgeries. If you consult with revision specialists, it may help getting a copy of your previous operative reports. Hope this helps. Dr Joseph

A tertiary rhinoplasty is a very difficult endeavor, so usually a thorough internal and external examination of the nose is required to make a determination. The tip of the nose can be conservatively lifted with a rhinoplasty procedure and additional cartilage grafts can be placed on the depression on the patient's left-sided nasal tip. It's important to know how much cartilage is left on the inside of the nose for potential grafting purposes. Releasing of the depressor septi ligament will prevent the tip from drooping when smiling. The hanging columella can also be reduced as well. For more information and many before and after revision rhinoplasty examples, please see the link and the video below

Your sequence of photos demonstrate some persistent concerns with nasal tip support, length, cartilage deformity left ala, over-resected dorsum and middle vault issues. In short, you could benefit from tertiary rhinoplasty with cartilage graft reconstruction, but your case requires a surgeon with exceptional skills and expertise. Since you are located in Chicago, I suggest you consult with Dr. Dean Toriumi at the University of Illinois at Chicago for a thorough evaluation. He will provide you with an honest opinion regarding the effectiveness of a tertiary procedure and then you can decide if you wish to pursuit additional improvement. Hope this helps.