Revision Rhinoplasty to Correct Crooked Nose, Alar Rim Graft, Alar Retraction, Unnatural Straight Profile?

Question

I underwent rhinoplasty more than 2 years ago that partially corrected crooked nose, reduced dorsal hump, and treated bulbous nasal tip. Nose is still deviated , there is palpable and visual presence of left ala rim graft, retraction of right ala rim, & straight contour of nasal dorsum. My surgeon is willing to revise it for free, but refuses to offer guarantees or show confidence due to presence of scar tissue, thick skin, resorption, complication of fixing crooked nose. What should I do?

Steven M. Denenberg, MD · Answer

Your nasal bridge: besides the bump that is still present, your nose is very strong at the top, in front of your eyes and just below your eyebrows. That part of the bridge needs to be narrowed much more, and I'll bet it wasn't narrowed in the first operation. Search Google for "Roman statue profile." We're trying to avoid the look where the profile line seems to slide from the forehead onto the nose without the little dip in the profile that we expect to see just below the eyebrows.
Issues of nostril rim height are very difficult to correct or control. However, if, for example, you might like a shorter nose, that would give additional opportunities to correct some of the tip asymmetry, and of course a sharp edge of a rim graft should be removed.
How *much* to lower the bridge, or elevate the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Stephen J. Pincus, MD · Answer

I'm sorry that you are disappointed with your result. Correction of a crooked nose can be challenging for even the most experienced surgeons. You have to judge this result and the expertise of your surgeon on how much of your nose was improved, how much stayed the same or was worsened, as well as your surgeon's track record, in general. Getting opinions from other specialists in revision rhinoplasty also helps to put things in perspective. You should go over each issue with your surgeon and see why he thinks that deformity is there and how he would take care of it. 
Obviously, if he has a record of revising many of his cases, that's not a good sign. But if you know of successful outcomes from other patients, your case may have just been an outlier.
Obviously, he knows your case well, and it would be cheaper than starting over with a new surgeon. However, if you don't believe he is capable of correcting it, then it's better not to have another unsuccessful surgery with more scar tissue & anatomical disruption !!

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Sorry that you're experiencing trouble with your outcome. Revision rhinoplasty can certainly be difficult and making guarantees is not often possible. Fixing a crooked nose is challenging but can be done. Visible grafts and contour deformities can be improved using various techniques. If desired, seek second / third opinions regarding what may be possible. It is always worthwhile to have input from multiple perspectives to see what may be realistic. Hope this is useful!

Revision Rhinoplasty to Correct Crooked Nose, Alar Rim Graft, Alar Retraction, Unnatural Straight Profile?

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Revision Rhinoplasty to Correct Crooked Nose, Alar Rim Graft, Alar Retraction, Unnatural Straight Profile?

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Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.