ScAred to undergo making collapsed nostril even again. (photos)

I have had a deviated septum fixed 15 yrs ago. Then rhinoplasty, then 2 revisions, and last one (6 years ago) to push up the columella..Post operation I had a collapsed nostril and the DR blamed it on me. With all the prior surgeries and bad experience w/ last DR, I'm scared to get it done. Maybe I shouldn't? I model for a living so besides being able to breath better id like it to be symmetrical. If it's too risky then it's ok.Would u recommend? And also can this be covered? Who u suggest? Thx!

Doctor Answers 1

Difficult dilemma with respect to revision rhinoplasty.

Dear kim9915 in Los Gatos, California

Frankly, you have a difficult situation there. It may be that your septum is still deviated and that could be repaired. Generally there is not much risk for that. If correcting the deviated septum is enough to improve your breathing, I would say that is very important.

With respect to the asymmetry and nostril collapse, any decision to have further surgery really has to be viewed very cautiously.

This is a very difficult surgery, often with a lesser outcome than one might want. You have already had 3 surgeries and there are going to be technical challenges.

My suggestion is that you have evaluation by a very experienced nasal surgeon superspecialist who is comfortable doing revision nasal septal surgery, as well as revision rhinoplasty. Lets see what the experts say. If you are a model, and I sense you have very attractive facial features in the photo, you may not want to risk any further problems. Perhaps, if you can breathe better and you can have operation to achieve that is not without great risk, then I would do that and perhaps “live with what you have.” Better to have some asymmetries and imperfections than perhaps complications and further difficulties.

It is very important to visit websites of surgeons who specialize in this type of work. Look at the before and after photo galleries.

I am not certain if you would qualify for nonsurgical revision rhinoplasty, temporary or permanent, but perhaps there is some opportunity there and that should be explored. Again, you want to meet with somebody who has a long track record of using fillers in leu of surgery.

When you go for consultation, definitely bring a friend or family member with you. You need to have as much input from those who would join you because often the consultations are complex and detailed and you want to walk out with as much information as was presented to you. Likewise, have a written list of questions before you go.

A consultation without computer imaging is, in my opinion, of much less value. Why shouldn’t you see the predicted result of the procedure the doctor is proposing? At consultation, photos are taken of you and loaded into a computer system that morphs your present appearance into the anticipated “after” based on the nasal surgeons input.

Imaging is an incomparable learning tool because it provides a forum for doctor and patient agreement on what would satisfy the patient and what is, in the doctor’s opinion, achievable. After all, cosmetic surgery is 100% visual. It is about appearance, so without a visual evidence of what is planned, how can you make a decision as to whether or not you might be satisfied. Talking about it is worthless.

To anticipate a successful outcome, there must be a meeting of the minds between surgeon and patient.

Best wishes,

Robert Kotler, MD, FACS
Over 4,500 nasal procedures performed

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 87 reviews

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