Nose caving in on the right. Any suggestions? (photos)

Question

I had revision rhinoplasty in June this year but my nose seems to have gone worse! My worms eye view is terribly uneven and from the front the right side of my nose is really pulled in making my nostrils look huge. After two nose jobs how rectifiable is this. I feel like my nostril has been 'pulled in' tighter than the other. So worried, don't know what to do.

Tanveer Janjua, MD · Answer

As much as it seems to be a difficult situation you can easily improve it with an Alar rim graft on the right side.regardsDr.J

Richard H. Tholen, MD, FACS · Answer

Thanks for your question and photo, but more information is needed, like pre-revision photos, and other views than a single worm's eye. But I will try to give an answer based on what I can see.First of all it is early in the 6-12 month recovery process, but what appears to be right nostril rim collapse (I would also want a dynamic examination with forceful inspiration to assess rim stability) may be present, or it could be asymmetry with relation to the opposite side or in response to a deviated nasal tip. In other words, does the rim collapse with inspiration, or is it simply malpositioned? Your alar foot plate (medial crus) also looks more protruding on the right side, contributing to the pinched appearance. It also is common that bleeding leading to (increased) scar tissue beneath the rim incision flap can both narrow the nostril opening and lead to a thicker-appearing nostril wall, as well as contracting and rotating the nasal tip to that side (right, in your case).Your open rhinoplasty columellar scar is also retracted and visible. Posterior subcutaneous columellar dissection would have equalized the edema anterior AND posterior to the scar, and perhaps better two-layer everting closure could yield a smoother result. Your present closure may have contributed to a poor caudal line on a profile view.After waiting for time to go by and swelling and scar tissue to diminish as much as possible, additional surgery may be appropriate. But only after careful evaluation and planning. Worrying won't accomplish anything, so take the time and start researching other experienced rhinoplasty surgeons if you feel the most recent surgeon is not capable of yet another revision with better results. Good luck and best wishes! Dr. Tholen

Nose caving in on the right. Any suggestions? (photos)

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Nose caving in on the right. Any suggestions? (photos)

Answers (2)

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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.