What Are the Best Options for Attaining Symmetry Via Revision Rhinoplasty? (photo)

If my goal is to reconstruct my nose to attain reasonable symmetry of (1) nasal bones, (2) nasal cartilage, (3) alar shape, (4) nostrils, (5) tip, (6) overall shape, (7) angle at which it points (currently crooked approx 4 degrees), what are my options? Currently, I'm leaning toward using my own rib-cartilage for reshaping and re-heightening of my nose. What are the pros and cons? Are there any superior options? Any advice is much appreciated!

Doctor Answers 3

What Are the Best Options for Attaining Symmetry Via Revision Rhinoplasty?

           You have some underlying asymmetry that is still present.   Unless this is corrected nothing is going to help in the way of onlay grafts.  The implant that you have has a nice smooth result.  If you are going to switch to cartilage the rib graft has a much higher tendency to warp than the diced cartilage grafts.  Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Revision Asian Rhinoplasty

This is a very common request from Asian patients who have received nasal implants for a previous rhinoplasty.  Because of the level of detail that is involved in your nose, an in-person evaluation is recommended so that the inside and outside of your nose can be properly examined.  Please consult with a board certified specialist in revision Asian rhinoplasty who can assist you in achieving the results you seek.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Symmetry may not be possible...

Hello 4Symmetry,

Thanks for your question.  Revision rhinoplasty under the best of circumstances is very difficult.  Your question about improving symmetry is a good one.  You are missing one view in your photos that we use to determine the chances for symmetry.  It is a preop and postop picture looking upwards from the bottom of your nose but it includes the cheeks to see if the bony base of the nose is asymmetric.  I noticed in your preop photo that you were already asymmetric to the right with what appears to be a deviated septum.  I am a big fan of silicone implants in Asian rhinoplasty with the understanding that the nose must be symmetric first to remain symmetric after surgery.  You need to have your cartilaginous and most likely, bony, asymmetries dealt with before you can really worry about nasal bridge augmentation, even with rib.  Asian male noses tend to be more oily with more fat in the nasal tip.  An L-shaped implant by itself may not give enough definition.  I like to use stacked cartilage grafting of the tip to really get definition, while at the same time gently defatting the tip area.

Preop and residual asymmetries of bone and cartilage will control the final shape of all areas you listed in your stated goals.

The reality is that noses are essentially always asymmetric and the base that they sit on is also asymmetric.  True symmetry is not possible, but close to symmetric is possible.  

Good luck,

Dr. Shah



Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 55 reviews

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