Asymmetrical tip of the nose, what would be the best way to fix? (Photos)

Question

I got a rhinoplasty 10 tears ago and about a year after my tip of the nose change the shape and got asymmetrical. I went to. Few surgeons and each one gave me a different answer some says I need ear or septum cartlige and some say they can fix it without. What should I do?

Afshin Parhiscar, MD · Answer

Dear LiZ889 From the limited views of you photographs, it looks like you have dome asymmetry that can be repaired by delivering and repairing the asymmetry. Your septum appears straight from what I can see. You have thin nasal skin and the transition between your tip and dorsum is my only concern. The entire asymmetry might be from a displaced/misplaced shield graft. Either way you might need some padding for transition  between your tip and rest of your nose. This is often done by using crushed septum, temporalis fascia or even cadaveric dermis.Look for an experienced plastic surgeon certified by the American Board of Plastic Surgery. See more than one consult. Make a well informed decision. You can have an excellent outcome.

Manish H. Shah, MD, FACS · Answer

Hello LiZ889 - Thanks for your question. I think an open tip rhinoplasty to reposition your tip cartilages would be necessary to fix what you see. You need other procedures as well to fix the appearance of the tip in all views.  Whether or not you need additional cartilage grafting would depend on what was found at surgery.  In addition, you have very thin skin that shows too much cartilage detail, so I would recommend soft tissue draping of the tip structures to camouflage the visible edges, etc. I would recommend that you consult with a revision rhinoplasty specialist in your area. They will be best able to fix this problem. Good luck, Dr. Shah

Toby Mayer, MD · Answer

you need to see a very experienced revision rhinoplasty surgeon. Besides tip asymmetry you also have insufficient projection of the tip as well as a poly beak deformity, a hanging columella, etc. Revision rhinoplasty specialists can correct these issues.  See a revision rhinoplasty surgeon who can show you excellent natural before and after photographs of post operative results in noses like yours. Do not rely on imaging but rather good actual results.

Mike Majmundar, MD · Answer

Thanks for the question.  There are several ways to get the same result; however, the best way to insure you have a long term result is by reinforcing the new infrastructure with more cartilage.  I think you will need more cartilage at least available to the surgeon in case some is needed.  You may already have a cartilage graft in the nose that can be reused.  IMHO, the existing cartilage needs to be separated, reshaped, sculpted, and sutured back with a cartilage graft to give it some long term stability.  Good luck.

William Portuese, MD · Answer

A revision rhinoplasty can accomplish making the nose more symmetrical, especially in the nasal tip. Suture techniques, asymmetrical cartilage removal, and cartilage grafting techniques will all be required to make this knows more symmetrical. Look for a very experienced Rhinoplasty surgeon for best results.

Michael Elam, MD (retired) · Answer

Dear Liz889, The good news is this can be corrected with revision rhinoplasty surgery. The revision would address the asymmetric tip by repositioning the tip cartilages. I would use an open approach so that there is a complete visual of the tip cartilages. It is unclear if you have a current graft that is mispositioned. Whether you need any grafting or not would be determined during the procedure. I would suggest seeking consultation with some experts in the field, have an intra-nasal examination and a proper diagnosis and surgical plan can be made. If your previous surgeon still has a copy of your original operative report this can always be helpful. Best regards, Michael V. Elam, M.D.

Andres Gantous, MD - Account Suspended · Answer

Hello,I am sorry that this has happened to you. The tip asymmetry is due changes in the tip cartilages that have occurred because of weakening of these structures. I would correct this via an open approach where we can diagnose exactly what the problem is and correct it appropriately. You may need some septal cartilage in order to support these cartilages and prevent any further changes down the road. There are different ways of fixing this and you need to find an expert rhinoplasty surgeon that you feel comfortable with.

Asymmetrical tip of the nose, what would be the best way to fix? (Photos)

Answers (7)

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