Flat bridge after primary rhinoplasty with fascia graft? (Photos)

it is too soon in the healing process to make any determination. This would be a guess and not a proper answer. You need to wait an additional six months and return to your surgeon. If dissatisfied seek a secondary opinion with a revision rhinoplasty specialist 

Hello,Thank you for your pictures and questions.  At 5 months, your nose will still undergo changes and healing.  The changes to the nasal bridge are typically loss of edema and this may may your bony humps more apparent.  The best course of action at this point is to be patient and to remain in close contact with your surgeon.  If you need revision surgery of your nasal bridge, you could have the bony humps shaved down and the region camouflaged with more fascia or a filler.  The reason you have these humps is likely an open roof deformity where the bones weren't completely fractured at the time of the original surgery.  This does happen and again, I would continue to have close and open communication with your surgeon.  He/she will be able to improve this.  Best of luck!

Usually, a final result to the bridge is seen at 5-6 months after primary rhinoplasty. However, when fascia graft is placed there is often lingering swelling that can take up to one year. If the area along the bridge lingers at 1 year then the graft should be revised by removing and refining with other optional grafts that can hide irregularities due to your thin skin.

Thank you for your photos. Areas of soft tissue swelling willl still continue to improve such as over the bridge or at the tip for several months, however hard bony areas are the least likely to change after this amount of time. The sharp step offs you feel are possibly edges of nasal bone which need to be shaved down. You may need a touch-up or revision procedure eventually to blend and smooth the edges, but it is prudent to wait until everything is healed and more stable before attempting to adjust the area. Hope this helps!Johnson C. Lee, MD Plastic Surgery

The healing process is not complete, however the bony ridgelines at the top of the nose will probably remain throughout the healing process. These "bony corners" can be rasped and filed down. Osteotomies may not be necessary. This is considered a touch-up procedure by  Your original surgeon.

Sometimes this area of the nasal bridge looks or feels prominent when the primary procedure involved removal of a large nasal hump. Often this is simply new bone callous formation of this area and typically, you may see further improvement over time. Any long term persistent prominence in this area can easily be improved with rasping and/or repeat osteotomies of the nasal bones. Give it some time before considering minor refinement. Hopefully your nose will continue to improve over the next 6-12 months. 

Residual nasal hump can be reduced with rasping that can be performed under local thus keeping your costs down; you can see this on instagram dr_laguna.

Thank you for the photos but try to be patient to see how things heal.  It does take about a year but express your concerns to your surgeonDr Corbin

Dear punkebrewster, If you feel step offs and they are bony in nature then you may require a revision procedure to address. The soft tissue swelling will still continue for the coming months so it is best to wait for all of the swelling to dissipate before considering revision. See your surgeon for a follow up appointment and he/she can provide a proper diagnosis and discuss a plan of action to address your concerns. Best regards, Michael V. Elam, M.D.

I would definitely feel that five months is too early to draw any conclusions.  Your surgeon might consider injecting very tiny quantities of kenalog in small doses to decrease swelling if it feels thick and "scar-like," however massage and taping for several months would be equally effective.  Assess at one year from your date of surgery.  Good luck.....Jon A Perlman MD FACS 



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