I need a revision. Any idea what happened to my nose? (Photo)

Question

So any idea what this dr did? I know I need a revision, the office it was done at told me to now follow up with a new dr since they don't want to deal with it. So now I'm just trying to understand why may have happened. It's been 9 months since surgery.

Andrew Miller, MD · Answer

From the photos, you appear to have some asymmetries of both the middle and lower cartilagenous areas of the nose. Revision would require an open procedure to identify and correct these problems. Sometimes grafts using septal or ear cartilage is needed, but if you can find a rhinoplasty specialist that performs a lot of revisions, you should have a nice improvement.

Steven M. Denenberg, MD · Answer

The tip of the nose is formed by two cartilages. If those cartilages are broad and strong, they make the tip of the nose look wide. But they do more than just contribute to the width of the tip.They hold the tip out away from the face. And they hold the tip down, so if someone has a droopy-tipped nose, or even just a nose that they wish had the tip up a little, it's work on the tip cartilages that accomplishes those changes. You didn't post profile views or three-quarter views, so I can't tell whether elevating the tip or bringing the tip back closer to the face would be important for your nose. 
The woman in the short video that I posted with this answer had the tip of her nose narrowed and elevated in her revision operation.The problem is that work on the tip cartilages is by far the most complicated part of a rhinoplasty, requiring expertise that most plastic surgeons don't possess. But from these photos, it appears that most of your tip cartilages are still there, still intact, so they could be worked on to get you much closer to your original goal.
How *much* to narrow or elevate the tip, or deproject the nose if that's part of the picture? 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 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 always 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 only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
Remember that rhinoplasty, and especially revision 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. As I mentioned, the changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, 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 for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging by the operating surgeon is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Tanveer Janjua, MD · Answer

The nose appears crooked from depression of right middle vault. It can be improved with cartilaginous grafts in that area. It will need a while for the swelling to get better after the revision surgery so be prepared for that. RegardsDr. J

Waleed Ezzat, MD, FACS · Answer

Thank you for your question. By the pictures you provided alone, your tip is asymmetric - likely secondary to some common tip maneuvers that didn’t work out.   Keep in mind that your tip may still change since you are still within a year.  If you are keen to improve the appearance of your nose, you will require a revision procedure. I would seek out a board-certified specialist with extensive experience in revision rhinoplasty somewhere in the northeast. If you’re going to get a secondary procedure (a revision), it is not unheard of to be willing to travel somewhere regionally to find the right person to fix your issue.In the meantime, stay safe and healthy.Dr. E

Thomas A. Mustoe, MD, FACS · Answer

You have significant asymmetry with some curvature to your nose with a bulbous tip and elevated nostril.  Much of not all of the problem is due to excess scar tissue which has resulted in different positions of the paired tip cartilages and loss of definition of the tip. That would also cause the left nostril to be elevated.   Revision will be more technically challenging than the primary rhinoplasty due to scar tissue.   Make sure your surgeon has experience with revisions.

David Nicholas Csikai, MD · Answer

It appears multiple things could be improved.  There was inadequate tip work performed. There may be a septal deviation along with assymetry or collapse of right middel vault. I would get multiple consults at this time for a revision.

William Portuese, MD · Answer

Much more information is needed, such as a full set of facial photographs from all angles, and a copy of the operative report. Revision rhinoplasty is more difficult than a primary rhinoplasty because of scar tissue formation  and previous alterations to the normal anatomy. Because of  these issues, an in-person consultation is going to be required. The thickness of the skin and the tip of the nose is also important, because thick skin prevents refinement in that area. Thick skin also requires  several cortisone shots in the first few months after the procedure to manage the soft-tissue envelope over the framework of the nose. The shots are just as important as the surgery itself, that's why follow-up appointments are imperatives with your operative surgeon.

I need a revision. Any idea what happened to my nose? (Photo)

Answers (7)

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