Uneven nostrils post Rhinoplasty. Any suggestions? (photos)

Question

I am 3 weeks post septorhinoplasty. I did not have this for cosmetic purposes. It was to correct a deviated septum and valvular collapse. There's a bump on the bridge of my nose and ridges above my nostrils. I'm assuming those will both correct. But what I'm really worried about are my nostrils. They're uneven and I do not see how this can correct itself. If this is something that requires additional surgery, am I going to have to pay for that? My first wasn't cosmetic and my ins covered it.

Brian M. Harmych, MD, FACS · Answer

Thank you for sharing your question. You are still very early in the postoperative healing period and likely have some changes that are due to swelling. Keep in mind that it takes a full year for all of the swelling to resolve after rhinoplasty; in cases where the nasal valve has been addressed it may take even longer- perhaps up to 18 months. With that being said there is definitely asymmetry of the nostrils and some distortion of the nasal tip which appears slightly more pronounced than I would expect for 3 weeks postoperative. Your best bet at this point would be to continue to follow up with your surgeon for postop visits and nasal examinations on a regular basis. It is possible that the asymmetry will improve over time. Keep in mind that a small percentage of all patients undergoing rhinoplasty surgery (5%, or more) will require revision. Any revision that might be necessary would almost never be performed prior to at least 6-12 months postop. Thanks again for sharing your question and photos. Good luck,Dr. Harmych

Emmanuel Mallol Cotes, MD · Answer

Thank you very much for enquire.It's too early to make value judgments with only 3 weeks after a rhinoplasty.Swelling after a rhinoplasty depends of the surgery complexity.In this regard, the nasal swelling Post-op It can last from two weeks to two months.To reduce this swelling, I recommend you perform delicates daily lymphatic drainage massage therapy over the face (around the nose) avoid sun exposure, and take pain/inflamation pills, as your surgeron precribe you.Kind regards, Dr. Emmanuel Mallol Cotes.-

Peter E. Johnson, MD · Answer

Whether you had any cosmetic changes or not, it appears that the tip cartilage just to the side of the "dome" or tip projection point has been weakened allowing a pinch to the tip on one side and the nostril asymmetry you see. Only with a complete examination can we know what is up but your photos do need to be shared with your surgeon to hlep sort things out.

Bradford A. Bader, MD · Answer

Thank you for the photos. They demonstrate the asymmetry clearly. It would be helpful to know the technique of nasal valve reconstruction (spreader grafts, batten grafts, lateral crural strut grafts, butterfly graft, alar rim grafts, etc) but this level of detail is sometimes not shared with the patient. Some of these grafts can impact the shape of the tip and nostrils. Another possibility is your asymmetry is a result of how the incision was closed. If the internal nostril incision is not lined up and closed perfectly it can distort the margin of the nostril and produce the result you have now. Your surgeon is in the best position to counsel you on this issue. I recommend you bring up your specific concern at your next visit. I really hope this improves with time but a revision down the road might be necessary. Best of luck.

Uneven nostrils post Rhinoplasty. Any suggestions? (photos)

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