What is the best option to correct my twisted , drooping and flared nose 3 years after rhinoplasty? (photo)

Based on your photo, you are a good candidate for revision rhinoplasty. The tip can certainly be lifted up some and supported so it doesn't spread so much when smiling. If you think the nostrils are too wide in general, they can also be brought in some. Be sure to see a rhinoplasty expert for consultation that can do computer imaging at the same time so you can get an idea of what can be done.

Asymmetries are nearly impossible to correct completely, but usually, when addressing the *size* of the nose (such as how you said it's drooping), it's possible to get a better correction of the asymmetries. Here's what I mean. I realize that we're only seeing one photo, and it's a smiling photo, which tends to lengthen and distort the nose, but indeed your nose looks long-ish, and you complained about that as well. Also, the columella, which is the piece of the nose at the bottom that separates the left nostril from the right nostril, seems to droop excessively on its own. If those issues were addressed in a revision, elevating the columella and shortening the nose, perhaps significantly, those two changes would, by themselves, help in correcting asymmetries, because any remaining asymmetries *look* smaller when they reside on a *smaller* nose. At the same time, there may be features, perhaps even inside the nose, that are contributing specifically to the asymmetry, and those might be addressed as well. This make sense?
How *much* to elevate the tip, or change the columella, 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, especially a revision, 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 needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery.

Hello and thank you for your question. Based on your photograph, you may benefit from a revision to help correct your hanging columella and tip asymmetry. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

These changes will require a revision rhinoplasty. We'd be able to adjust the cartilage and skin to get your nose more secure and where you would like it.

I have a practice where I perform a great deal of revision rhinoplasty. I do not think that your revision would be particularly difficult and in the hands of a good rhinoplasty surgeon you should be able to get the nose to appear how you had always envisioned it to be. Some of the things that could be corrected are a hanging columella, dipping of the nose when smiling, alar reduction, narrowing the dorsum, and perhaps lowering the lower dorsum to give a more feminine appearance.

It is common to have alar asymmetry, however this can be due to a variety of factors. A component of this is the positioning of the lower lateral cartilages as well as the overlying soft tissues. This would be best addressed with a revision rhinoplasty to ensure symmetric positioning of the lower lateral cartilages which could also correct the excess infratip and provide further tip refinement. Once cartilage positioning has been addressed, if there is residual asymmetry alar base resection may be necessary to further correct persisting asymmetry.

Much more information is needed, such as a full set of facial and nasal photographs from all angles to make a determination about how best to proceed. The reason for this is that the nose is a three-dimensional structure, and revision rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery. It would also be helpful to have a copy of the operative report from the first procedure to find out what maneuvers were performed at the first rhinoplasty. From. this one limited photograph, it appears that you have a hanging columella, but that must be verified from a side profile photograph