Had Poor Results From Primary Rhino, Having Trouble Coping. Suggestions? (photos)

This is a question I posted earlier but with pictures. Pictures were requested by one of the physicians that responded.I recently had a poor rhinoplasty 3 months ago. I had a slender nose with a nasal hump. The result is an extremely thin bridge that is scooped out. Possibly an inverted V deformity. It is difficult for me to go to work. I am horrified. Considering a nonsurgical alternative mentioned by one physician. What are risks if you do nonsurgical sooner than one year post op?

Doctor Answers 5

Correction of Inverted-V Deformity

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Thanks for the photos and question. You do appear to have an inverted-V deformity, which refers to collapse of the upper lateral cartilages towards the middle of the nose along the bridge. This is what is causing your bridge to appear narrow and pinched on front and 3/4 views. 

In my opinion, your best option would be revision rhinoplasty. I would  recommend placement of long, thin cartilage grafts (spreader grafts) on each side of the septum along the bridge. These grafts, taken from your septum, will lift your upper lateral cartilages outward and improve both form and function of your nose. These can be placed in such a way to raise your bridge back up, as to eliminate the "scooped" appearance. Rasping (filing) down your nasal bones may also be appropriate. 

As for the use of filler, it's possible that you could camouflage the issue by injecting filler along each side of the bridge and from your hump down to your tip, to straighten your profile. There are a few considerations with the use of injectable fillers in your case. First, be sure to visit with an experienced rhinoplasty surgeon who also performs this "nonsurgical rhinoplasty" using fillers, to make sure you are informed about the benefits and risks of both approaches. Secondly, I would begin by using a reversible, temporary filer such as Juvederm, Restylane, or Perlane. These products can be safely and comfortably injected in the office to correct contour issues following rhinoplasty. The products typically last around a year (sometimes longer) in the nose, but can be reversed immediately if you are unhappy with the results, by injection of an enzyme called hyaluronidase (Vitrase). There is also minimal scarring created in the nose with these products, should you later need revision surgery. The timing (3 months following surgery) is not an issue, in my opinion. Thirdly, I would not recommend the use of permanent fillers, particularly silicone. I have seen many problems in patients who have had these injections with other physicians. The last thing to discuss is whether you are having any difficulty breathing. Collapse of the upper lateral cartilages can narrow the internal valves of the nose and insurance coverage may be possible for a portion of your surgery. Use of fillers would not improve your ability to breathe, as the product would be placed above, not below your cartilage. 

Best regards,

Dr. Mehta

Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Poor Rhinoplasty Results and Trouble Coping

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I don't believe injectible fillers will give you long term results and may complicate future revision rhinoplasty. You should consult with 3 to 4 surgeon and consider revision options including cartilage and/or gortex graft overlay. As far as coping, you may want to consult a mental health professional.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 reviews

Using non-surgical rhinoplasty for initial rhinoplasty result

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I'm reluctant to use fillers to treat the type of issues you want addressed. Revision surgery would best address the problems you mentioned. This soon after surgery a filler injection may be difficult to properly place. There are also rare instances of skin injury after filler injection.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Coping after rhinoplasty

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this is the kind of situation where specific meidcal advice over the internet is unwise

however, if one is feeling really uncomfortable/cown about a result one should discuss this with the plastic surgeon and seek appropriate assistance

revision can be done at a year

fillers can be used but there are reports of tissue necrosis.

Adam Bryce Weinfeld, MD
Austin Plastic Surgeon
4.9 out of 5 stars 63 reviews

Post-rhinoplasty issue

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At this point your nose is also swollen.  While you can inject some filler, it will not resolve the problem permanently. You may need a rhinoplasty revision.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.