Would a closed revision rhinoplasty straighten my nose? (Photo)

Question

I had a failed rhinoplasty. I still have a deviated septum and crooked nose. surgeons have suggested a revision rhinoplasty with rib grafts but that sounds intimidating and invasive to me. One surgeon with over 30 years of experience mentioned that he could straighten my nose without using a rib graft successfully and correct my deviated septum, so I could breathe. Is this something I should trust? I just want to be able to breathe and would appreciate if my nose was in crooked :(

Randal Haworth, MD, FACS · Answer

It's understandable that the idea of a revision rhinoplasty with rib grafts can be intimidating and invasive. However, it's important to keep in mind that every individual's situation is unique and requires an individualized approach. While some patients may require rib grafts to achieve the desired results, others may not.

It's encouraging that a surgeon with over 30 years of experience has suggested that he can straighten your nose and correct your deviated septum without using rib grafts. However, it's important to schedule a consultation with this surgeon and ask questions to better understand his approach and experience with similar cases. You may also want to consider getting a second opinion from another experienced and reputable surgeon to ensure that you are fully informed about your options.

Ultimately, the most important factor is choosing a surgeon who has the necessary experience and skill to achieve the results you desire while ensuring your safety and minimizing the risk of complications. Be sure to thoroughly research potential surgeons, ask for before and after photos, and read reviews from past patients before making a decision. It's also important to have realistic expectations for the outcome of the surgery and to carefully follow postoperative instructions to ensure optimal healing and results.

I hope this helps,
best of luck !

Jeremy S. Nikfarjam, MD · Answer

Hi Revision,You hit the nail on the head here- I tell all my patients that there's no good in having a "beautiful" nose if you can't breathe well! Yes, a revision septoplasty could be a good option for you. Some sort of cartilage graft (rib or cadaver) is a common option for revisions to help re-build integrity of the nose. If I were consulting with you, I would want to perform an internal nasal exam to see if surgical intervention would help or hurt your ability to breathe well.I wish you luck on your search for treatment!- Dr. Nik

Eric M. Joseph, MD · Answer

If you have adequate amounts of nasal septal cartilage after your first Rhinoplasty, This may be a better source of cartilage for nasal reconstruction than rib cartilage. Please consider Consulting with several reputable rhinoplasty specialists who offer computer Imaging so you can see what might be best for you moving forward. Hope this helps! Dr Joseph

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.I have tried to evaluate your case from the photos and information you provided. It would be better of course if you can provide more photos but from what I can see, I recommend you a revision rhinoplasty surgery to correct your breathing issue and make your nose straighter. Please keep in mind that 100% symmetry is not achievable, but it would of course be better than now. When it comes to open or closed surgery, I cannot say anything for sure now without consultation, but from my experience I recommend you open revision rhinoplasty surgery with rib cartilage reconstruction. I understand that you may think it is too invasive, but believe me you won't even feel the incision (from where the rib would be removed) and it is the most successful method.

Nima Shemirani, MD · Answer

Hi @Revision616. I recommend seeing an expert revision rhinoplasty specialist for an in person examination. There are several options for you that can be determined after examination. Rib harvesting is sometimes necessary in revisions if the septum and supporting cartilage of the nose have been weakened. This will give more strength and support to the nose. Rib harvesting is commonly used in revision procedures. Best of luck to you, Dr. Nima!

Steven M. Denenberg, MD · Answer

When considering a revision, it's important to look at *everything* that bugs you about the current nose. You only mentioned the asymmetry, and you only posted that frontal view, but it seems to me that the lower half of your nose is still rather wide, and the lower part of the tip seems to droop. If those are true features that are present on the profile and three-quarter views, then they should be addressed as well. A good surgeon would be able to let you know, as accurately as he can, how much improvement is most likely in his hands. We can never be 100% certain about it, but there are features that are more predictable to correct than others, and a good surgeon would, should, decline to operate if he thinks that he can only make an improvement too small to be worth having the surgery.
How *much* to narrow that part of the nose, or elevate the droop, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose in particular needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Tanveer Janjua, MD · Answer

Yes, closed approach without grafting can be used to do revisions. It all depends on the experience and comfort level of the surgeon. If she/he has performed these procedures and had good results then it is ok to get it done.
Regards
Dr. J

William Portuese, MD · Answer

A closed  rhinoplasty and certainly improve your nose, but it may not be completely straight to do a variety of factors present already. A full set of facial photographs and a copy of the previous operative report would be helpful. It's important to know how much cartilage is left over on the inside of  your nose for potential grafting purposes

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! Thanks for your photos and questions. Straightening a nose is very difficult. Many times, not only bony work needs to be performed, but major septal reconstruction as well. Grafting material from the septum or rib is used to straighten the cartilage and provide support. I find open structure to be the most conducive to accomplishing that goal. Closed approaches provide limited access and can serve a role in rhinoplasty, though more limited compared with open in my opinion. Keep researching and meeting with surgeons who perform both types to see who you feel most comfortable with. Best of luck!

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