Am I able to achieve this button nose with fillers? (Photo)

Question

I had an open rhinoplasty two years ago however I wasn't happy with the results. Also I feel as though my nostrils are uneven. Am I able to achieve this button nose grouch fillers or do I have to resort to a second rhinoplasty?

Jason Emer, MD · Answer

Hello and thank you for your question. You have a tricky problem to fix. It sounds like your biggest concern is you'd like to alter the shape of your tip, and you have asymmetric nostrils after a prior rhinoplasty, as you mentioned. The asymmetric nostrils 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 in your tip and alae, 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 recurrence of the alar retraction. 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

Nonsurgical rhinoplastic treatments are typically not useful for providing a narrower nasal tip appearance. Adding volume to your tip may make it wider. It may be best consulting with several reputable rhinoplasty specialists so you could see what might be best for you moving forward. Thank you. Dr Joseph

Nizar Taki, MD · Answer

Thanks for your questions. Based on your photos, fillers could get you closer to the nose you have pictured - but not completely. Also, fillers cannot correct the unevenness of the nostrils.

It's important to understand that the risk of skin necrosis from an injectable rhinoplasty is significantly increased after already having had a surgical rhinoplasty, because of the disrupted blood supply to the nasal skin. Since the injectable rhinoplasty is not permanent, you will have to repeat the injections, and expose yourself to this risk multiple times. Therefore, if you truly desire a significant change in the shape of your nose, you should probably consider a revision rhinoplasty. 
I recommend seeking a consultation with a board certified plastic or facial plastic surgeon who is experienced in injectable and revision rhinoplasty.

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Am I able to achieve this button nose with fillers? (Photo)

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