7 months post op revision rhinoplasty and noting a huge depression in cartilaginous part of the nose? (Photo)

Question

second surgery was an open septorhino, and the last month I have noticed a depression in the cartilaginous part of the nose past the keystone area. i still have a small dorsal bump, which I’m fine with as its a naturally occurring imperfection but after the bump transitions into a very noticeable depression, which gives an impression of false upturn/supra tip break. What is the best way to fix this depression in cartilage? A closed revision in which a cartilage Onlay graft can be used?

Steven M. Denenberg, MD · Answer

It can be very hard to get a graft in that area to sit symmetrically and look natural *and* accomplish what we'd want it to accomplish. It might be more predictable to lower the projection of the tip a bit, so the area above the tip no longer looks depressed, and then lower the bump a little bit as well, so the bridge line looks good -- matching the depressed area by bringing the tip back closer to the face would probably make the bump look larger, and we probably wouldn't want that. So with that plan, there wouldn't be a graft, but yes, it's more work.
How *much* to bring the tip closer to the face, or lower the bump, 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 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. 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.

7 months post op revision rhinoplasty and noting a huge depression in cartilaginous part of the nose? (Photo)

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