Dent on bridge after revision rhinoplasty 4 years ago - how can I fix this without filler? (Photos)

Hello and thank you for your question.

First off, it's important to recognize that complications happen to ALL surgeons, and any surgeon that does not have complications or any suboptimal results is either not operating enough or is lying.

With that said, although an exam in person is ideal, from your photographs alone, I agree that you have an indent but there is also a subtle asymmetry visible from the left and right oblique views where some subtle fullness is appreciated along your supratip/midvault (middle third of your nose). I would recommend a resection of this fullness and if you're against any filler to address the indent, I would recommend a soft tissue graft to improve the indentation. I commonly use mastoid fascia or morselized bone graft to achieve this.

Revision rhinoplasties are difficult in general, but undergoing multiple revisions increases the complexity and difficulty further. The surgery I perform to achieve your goals would likely involve excision of any soft tissue scarring, in addition to placement of extended spreader grafts to streamline the aesthetic lines from the dorsum to your nasal tip, locked into a columellar strut graft. I would also place a mastoid fascia tip graft between the reconstructed tip complex and your skin to reduce cartilage prominence (tenting up of the nasal tip skin by cartilage)/

Due to your prior rhinoplasties, the cartilage in your septum was likely harvested and so you will likely require MTF (Musculoskeletal Transplant Foundation) aka cadaver cartilage to perform this revision rhinoplasty. Also note that if your septum is deviated and you have breathing difficulty, a revision septoplasty may benefit you as well, which can be covered by health insurance, lowering the price of the surgery overall.

The next step for you is to pursue the right aesthetic plastic surgeon for your revision rhinoplasty. In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, IN PERSON, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. I also think a key component of your consultation is to establish a good connection with your plastic surgeon. This is difficulty to do without seeing your surgeon in the office, in person. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.