Is my nose pinched and over-resected? How to fix it? (photo)

Question

I'm 1,5 year post op. I have redness in my tip and impinged pronounced line running down my nose and around - looks like a finger. My columella is twisted. lt looks like the top part of my nose is separated. Is my nose pinched? I never had this in my life. My upper bridge area looks overly resected. I'm miserable and do not know what to do... My life and my nose is ruined. How is it possible to fix it?

Gerald Minniti, MD, FACS · Answer

Hello,
It does appear the bony part of your bridge was reduced. Based on the pre-operative photos, it appears that was not needed, but a physical exam of your nose would've made that assessment more certain. Had I seen you (based on your photos), I would have only reduced the distal septum (near the tip), and reduced the projection of your tip. At this point, if you want changes to your nose, a revision surgery is necessary. In addition to augmenting your bridge, minor tip modifications can be made to achieve a less pinched appearance using structural techniques, which requires cartilage grafts. In the case your tip, there is probably enough excess septal cartilage to meet the graft requirements. For your bridge, you'll need diced cartilage from a rib, which is wrapped in fascia and placed on your bridge; anything else (like ear cartilage) will be insufficient and/or cause visible deformities. Go visit a few ABPS certified/ASAPS member surgeons who specialize in revision rhinoplasty. Best of luck!

Victor Chung, MD · Answer

Rhinoplasty is a surgery to improve the shape of your nose for breathing or appearance. A reductive rhinoplasty is one in which bumps and extra tissue is removed to make the nose smaller. If the nose is over-reduced, tissue (cartilage) needs to be added to create support and shape, this is called a structure rhinoplasty. With additional support, pinching and collapsing may be avoided for a safe and happy result. Safety comes first.

R. Laurence Berkowitz, MD · Answer

Your assessments are accurate in my opinion based upon the photographs you have provided. Restoring some of the resected tissue in the bridge and sides of the tip will go a long way to improve your situation. You will need adequate donor cartilage for this and if your septum was not touched it may be enough. You will be learning about terms such as spreader grafts, diced cartilage wrapped in fascia (DCIF) and lateral crural extension and alar contouring grafts. The redness is a harbinger of very thin skin over the tip so an extremely patient and careful dissection may be required. Visit with a rhinoplasty expert--board certified plastic or facial plastic surgeons. The Rhinoplasty Society can help you find someone with this type of skill.

Andre Panossian, MD · Answer

In your particular case, you really would need an in-office consultation to evaluate your nose and discuss any further intervention and the risks posed by additional nasal surgery. Sometimes, additional surgery is not the answer. With that said, your photos show several issues. One is that your radix (top of the bridge) is low and would benefit from a small augmentation. Second, you have just a bit too much columellar show that is accentuated when smiling. Third, your nostrils appear flared when smiling. This could be a visual effect from reducing your upper and middle thirds of the nose. This would need to be narrowed a bit. Again, these are just some observations and not recommendations. Only with an in-office consultation can a formal revision rhinoplasty plan be made.Read about Dr. Panossian's approach to rhinoplasty.

Richard W. Fleming, MD (retired) · Answer

The pictures do show that your nasal definition, projection, and proportions can be improved with cartilage grafts. Consult with an experienced revision rhinoplasty specialist. Your reconstruction will be challenging.

Is my nose pinched and over-resected? How to fix it? (photo)

Answers (5)

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