Good Question. So there is no easy answer. ALL revisional surgeries are difficult. Outcomes are more unpredictable. In order to get a good outcome you will need cartilage grafts from either septum or ear. This will give you native cartilage support as it appears as though the previous surgeon removed too much cartilage leading to collapse and asymmetry Therefore you can improve it but it wont be a chip shot
pixiegirl78,You don't mention how long ago your rhinoplasty was but in my experience a nose with the degree of asymmetry that you have in your tip and the margin of your nostrils will only get worse, to a significant degree. It also appears that there is asymmetry in the nasal bones. To correct the tip asymmetry your nose will need to be disassembled and reassembled in the midline with the proper support for the tip. This will probable include the use of alar struts, a tip graft, battens, possible lateral cruel repositioning and a temporals fascia graft to address the thin skin and soften the external contours. If the revision is not done correctly and completely the outcome will be unsatisfactory and a nightmare to correct.
revision rhinoplasty is always a more complex procedure thanprimary rhinoplasty. Having done these for more than 35 years it is likely that curtilage from your septum or ear will be used for grafting. I need to see better photographs since your nose looks crooked as well with the limited Photos submitted. Choose a very experienced revision rhinoplasty specialist who does natural noses and can show you many examples.
Dear pixiegirl78, You will need to have an examination to determine exactly where the asymmetry is coming from. A copy of your original operative report would be helpful to the consulting surgeon to understand what techniques were used during your primary procedure. If this is simply adjusting the tip cartilages then the revision should not be very complex however it is difficult to determine the exact cause with these photographs alone and no examination. Seek some consultations with experts in the field and then your questions will easily be answered. Best regards, Michael v. Elam, M.D.
The revision of your tip would not be easy but improvement can be achieved if the surgery is done by a revision specialist.With just these pictures it is difficult to determine what is causing your problem. Was a tip graft used? Do you have soft lateral tip cartilages that have collapsed? Is there an adequate amount of cartilage to support your tip? After consultation you can make an educated decision about a revision.
Revision rhinoplasty more difficult than a primary rhinoplasty, takes longer to perform, and is more expensive. To fix the asymmetric and crooked nasal tip will require cartilage grafting techniques, so is important to know how much cartilage is left over on the inside of the nose after your primary rhinoplasty. For more information and many before and after results of crooked nose repair, please see the link and the video below