Should I have a fourth revision rhinoplasty? (Photos)

Question

It has taken 3 infractures and two alar reductions done over sixteen years to get me to the point I am at now. My original surgeon is pretty well known in town for his professionalism and his work with cleft plates and surgical reconstruction. There are no cases of malpractice from him that I know of. He suggested that he could do a fourth infracture to narrow the bridge further. My last surgery was in 2008. I would like a slightly narrower bridge and something less bulky.

Alejandro Nogueira, MD · Answer

To narrow the dorsum, firstly... you have to narrow it! do suggest this to your surgon... infracturing a nose without previously narrowing the osseous dorsum is... just infracturing a nose. Sounds silly but is real and trustworthy strategy.To narrow a dorsum you have to do paramedial saw reduction of the synostosis betwen osseus septum (center) and nasal bones (sides).Advice: McCarthy's Plastic Surgery textbook, Head and Neck manuals, Dr. Sheen's rhinoplasty chapter.Additionally there are other issues in your nose: nasal pinching, not very good tip outcome, poor definition, and massive irregularities (suitable for temporal fascial hiding).Let me finish telling you I'd never perform a congenital craniofacial surgery in a newborn, toddler, child, teenager or adult... even though I am massively experienced in cosmetic and revision rhinoplasties, the former is not my expertise and the latter does not authomatically entitle my experience in it.

Michael R. Menachof, MD · Answer

The risks following a rhinoplasty increase with each revision.  With that said, it does look like all you need would be to infracture the nasal bones, and by itself this should not increase the risk significantly.  Given that you have had 3 previous rhinoplasties it would not be a bad idea to consult with another experienced rhinoplasty surgeon in your area for a second opinion.  I'm not suggesting you go to another surgeon just that getting another in-person opinion might make you feel better about going ahead with your original surgeon.  Good luck.

Should I have a fourth revision rhinoplasty? (Photos)

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How close to my old nose can I get with revision rhinoplasty? (photos)

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