Should I get my nose bridge increased again? Skin is too thick to decrease nose tip from the side

Question

I have having a revison with same surgeon. Should I get the bridge increased? My nose tip cannot be decreased anymore from the side but he can decrease the width from the front. My skin is too thick. I also lack definition from the front making my nose fat & wide. What can Be done about this? My nose was shorterned however cartilage has become soft and tip has dropped. Surgeon wants to use rib cartilage now for long term results in the columella as my skin is thick. I am now 2 years post op

Alejandro Nogueira, MD · Answer

From the photos it seems the rhinoplasty produced a slight over resection of the dorsum, not that far so can be called saddle nose, just a dip near the radix causing an odd effect of double radix angle; to clarify, the over resection is minimal and happens at the juction of the upper third and the lower two thirds of the dorsum, point where the neo-radix has been formed.The main goal in your case is getting rid of this dip or neo-radix and building a perfect triangle with the dorsum in straight fashion.Being a minor problem we have 2 options:-the simple: making the small triangle >>> we consider you need a small nose and we deem the upper third of the dorsum as correct, thus the option would be shaving down a bit the lower two thirds of the dorsum and, accordingly, shortening a bit the tip projection to even it with the newly build straight dorsum.-the complex: opting for the large triangle >>> we decide that the upper third of the dorsum is too low and needs a (very small) cartilage graft taken from the ear (rib cartilage is an atrocity in your case), and eventually a fascia layer to hide irregularities; thus we obtain, like in the previous method, an straight dorsum.Both options are acceptable, not it is up to you deciding and, of course, seeking better opinions with experts in revision rhinoplasty with less surgical exhibition aims.Other finesss is feasible in your nose: refining the tip, grafting it to make more feminine, lowering the nasolabial abgle, septal lenghtening, etc, all optional and discussable, much better with computer imaging simulation in person at your surgeon's desk.You need to find a good and juditious revision surgeon.

Manish H. Shah, MD, FACS · Answer

Hello eliza bethany,Thanks for your question.I do think that you need some more dorsal augmentation to raise your bridge.  Use of rib cartilage would be fine.  I do think that some mild alar base narrowing would help, and it is possible to get a mild improvement in tip width with the assistance of tip grafting.  A columellar strut graft can reinforce your tip position.Thick skin will ultimately limit all surgical outcomes so be realistic about your outcomes.Good luck with your revision surgery.Dr. Shah

William Portuese, MD · Answer

It is possible to undergo a revision rhinoplasty to build up the bridge of the nose, but adding a rib graft is rather major surgery, especially if there is enough cartilage left on the inside of the nose for grafting purposes. Adding a rib graft to the bridge of the nose will also make the nose wider and  fatter and harder, since you are adding bulk to the nose.

Dennis Barek, MD (retired) · Answer

Your nose appears unbalanced, with a heavy tip and relatively low bridge.With the thick tip, not much can be expected with a tip procedure. Raising the dorsum, at its low point, near the upper 1/3, will bring balance to the nose. Septal cartilage would be my first choice for graft material, since it is thin and add layers. Its also less likely to warp.

Should I get my nose bridge increased again? Skin is too thick to decrease nose tip from the side

Answers (4)

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