Candidate for revision rhinoplasty due to cartilage? (Photos)

Question

I had a septo-rhinoplasty done by a great surgeon in 2019. On the left side of my nose, there is a bump. I recently went to my surgeon and they said it was cartilage and not scar tissue, and that cartilage has a “memory” and can try to go back to original shape. it causes my nose to look slightly crooked/larger on the left side. The surgeon said they would not recommend revision rhinoplasty due to potential complications. Can a revision cause more issues than what it’s worth?

Alejandro Nogueira, MD · Answer

If I had to choose... I'd always go for scared surgeons and stay far from great surgeons, at least you have guarantee the doctor won't try to accept a case beyond his technical skills.

The great surgeon achieved in your nose:
-open roof deformity (he didn't do osteotomies, back-to-school case?)
-inverted V deformity, total collapse of middle vauld
-the septum arises in between the open roof, there is a crest also due to poor dorsal refinement 
-bad damage to tip domes and/or their support, uneveness is iatrogenit and needs repair
-untreated and aggravated verticalized lateral cruras (boxy tip / parenthesis tip), the surgeon did plication with sutures (cool and easy, isn't it? wasting time in repositioning and rim grafting is time boondogle?) which has incresed the verticalization and boxytipedness
-overly rotated tip, nostrils visible from the front, probably due to a improper caudal septum resection (that's the furthest I can go)

IMO both surgeons, the great and the scared, share similar technical level, one of them was honest with you.

Seek the help and advice of a real structure and revision rhinoplasty surgeon that can fix this mess in 4-5 hours of state-of-the-art surgical procedure, not a great one, neither scared.

Eric M. Joseph, MD · Answer

Just on what I see, you appear to have a deeper supra-allar crease on your left compared to your right. If you are looking to improve upon nasal tip symmetry, microdroplet Silikon-1000 injections maybe considered for adding volume to the deep left crease, for a less operated and more symmetrical nasal appearance. I hope this helps! Sincerely, Dr Joseph

Steven M. Denenberg, MD · Answer

The bump that I see seems to be the prominence of the curvature of one of the two cartilages that forms the tip of your nose. Usually, to make a tip, or part of a tip, more narrow, the cartilage is re-shaped in a way that doesn't *allow* the cartilage to regain its original shape. The bump that I see is on the right side of your nose -- the left side of the posted photo. Am I seeing correctly?

Anyway, it's just about impossible to figure out definitively what to do based on photos. What you would need is an in-person exam to see what's causing the bump. If it *is* the curve or position of a cartilage, I think of those problems as a reasonably predictable change to make. Certainly not something that you just have to live with, if it bugs you enough. But that's what you would want: the answers to: what's causing this bump? Why is it still here? What would you do to fix it? How much can it be improved? How likely is the surgery to work? Will the results last? That would be a mandatory minimum list of questions!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include nasal tip deprojection, placement of a mastoid fascia tip graft for improved tip contour, among other maneuvers. 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

Best wishes and good luck.

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

Candidate for revision rhinoplasty due to cartilage? (Photos)

Answers (4)

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