My nose tip and bridge were both redefined with grafts from my nasal septum 4 years ago. I noticed after a year that both my tip and nasal septum have shifted to the left, but it wasn't apparent until now when most of my swelling and scar tissue has healed. Was this shift caused by extracting the septal grafts, and is it the main reason for my nose tip deviation? Is there a chance it will continue to deviate my tip?
Nasal Septum and Nose Tip Implant Shift
Doctor Answers 9
Nasal Surgery has a 15% re-operation rate
There is nothing more frustrating for a plastic surgeon then to see perfect work twist or turn. This is one of the inherent problems of Rhinoplasty surgery, especially the more complicated treatments requiring cartilage grafts. This happens partly because scar tissue causes contraction and pulling of the surrounding tissue. Scar tissue may not occur in a symmetrical fashion. The pulling can distort the shape of the nose. This can happen in the first 2-3 years, after which your nose has probably reached a steady state. So most likely, "what you see, is what you get?" As for correction, the forces that affected you originally are still there, even in the best surgical hands, some twisting may occur after further surgery. As a doctor that performs many revision rhinoplasties, I find it important to always advise patients that we can make it look perfectly straight, and then it will have a mind of it's own and twist. So find a great doctor and understand that twisting can reoccur.
Robert M. Freund, MD, FACS
Grafts may shift over time and the appearance can change as swelling resolves.
Sometimes the changes continue subtly over many years. Because we are creatures with living tissues, those tissues change over time, even surgically shaped tissues.
Consult with your surgeon to compare your before and after photos and to see if some revision is advisable.
Nasal surgery sometimes need to be revised.
With any surgery, there is a risk that you may need a revision. Nasal surgery is very complex and small changes after surgery (in the millimeter range) are very apparent since your nose is right in the middle of your face. Also, when you use grafts, there is always a chance for warping. My suggestion at this point would be to go back to your original surgeon for a complete examination. He or she will be able to give you a better idea of what needs to be done to correct your current problem. Go luck.
David Shafer, MD
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Nasal septum and nose tip recovery process
Rhinoplasty is a popular and effective surgery to recontour the shape of your nose. Patients undergoing a rhinoplasty should understand recovery process. Immediately after the surgery, you may experience some swelling throughout your nose. This swelling may fluctuate after your nasal surgery. Although uncommon, it is possible that some of the cartilage grafts that were use in your nasal tip may shift out of place. If this occurs, you may notice some asymmetry once your nose has completed the healing process. If the uneven area is noticeable, you may benefit from a small revision surgery where this cartilage graft may be removed or modified.
Unlikely to deviate any further
The shift in the cartilage grafts from the nose is probably caused from natural contraction phase of healing. Each time a graft is placed in the nose there is a small amount of scar tissue that forms a capsule around it, which can cause some portion of the deviation. There are other reasons for nasal tip deviation that include twisting and asymmetry of the lower lateral cartilages, the upper lateral cartilages, or the nasal bones. At this point since it is approximately a year after the surgery it is unlikely to deviate any further.
The shift was probably due to scar contracture.
After nasal surgery the nose typically stays slightly swollen for one year. Though there are many causes of deviation, the usual cause is scarring which pulls the tip and or bridge to one side.
It is unlikely that the graft removal caused the problem since this usually leads to collapse, not deviation.
I have been doing nasal surgery for more than thirty years and these problems can occur with excellent surgeons. It will not further deviate and can be fixed by the original surgeon or any good revision rhinoplasty surgeon.
Nasal Tip Movement and Nasal Septal Deviation a Year After Rhinoplasty
Your question is best answered by your surgeon as only he/she knows exactly what went on during your rhinoplasty. Your surgeon also knows the progression over time of the deviation.
The nose continues to change for many years following rhinoplasty. Usually there is some contracture of the skin-soft tissue envelope of the nose. That is why it is essential that the rhinoplasty surgeon leave a strong well structured nasal foundation of cartilage and bone at the completion of the operation.
When the structure of the nose is left weak by excessive removal of support, a nose that initially looks great for the first year or so will seem to "morph" into a pinched "done" looking nose as the skin shrink-wraps down onto the underlying cartilage and bone. Likewise, in thin skinned noses, cartilage grafts that have been improperly shaped, secured in place, or inadequately covered may become apparent.
Each nose is unique, and no two operations should be exactly the same. The deviation of the tip of your nose may or may not continue. Deviated septum’s have multiple causes, but not usually from removal of graft material.
If you decide upon a revision rhinoplasty, you should have an "external or open" approach so that the structure can be evaluated directly and any grafts can be precisely sutured in place. Good luck and be well.
Deviation can happen
Deviation of the septum is normal in most people. At the time of surgery to harvest septal grafts, I will correct nasal septal deviations. Sometimes the septal strut will shift over time and even grafts placed can shift a bit. If it is very obivous then I would recommend correcting it.
Nose Shifting After Rhinoplasty
Rhinoplasty is perhaps the most difficult procedure because not only must the nose look good, it must look good over time. It is akin to creating a 'biologic tissue sculpture". There are several reasons why a nose may look good and then subsequently look more crooked:
- Swelling- Nose may have always been crooked and now revealed once swelling dissipated
- Persistent Deviation of Septum- Underlying septum may be deviated
- Post surgery trauma- Nose may have been hit in the early recovery period
- Scar contracture
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.