Can my nostrils be evened out? (Photos)

Question

I had my first rhinoplasty in spring of 2014. Was told my blood was very watery at the time and I bled a lot. Resulting in a lot of scar tissue and poor breathing. When I was woken up I moved very fast and bled from this nostril. During packing removal I believe a stitch ripped. A cotton ball was placed and it seems my skin healed around it A year later spring of 2015 I had a revision to help with the breathing and fix the nostril. The nostril seems untouched. The breathing improved as I used to whistle a lot. I still feel my breathing is not what it used to be. My main concern is the nostril & hanging columella (?) I believe that’s what it’s called Within the last 3 years I had hydrocortisone injected into the tip the the nostril to help with the scarring but it did not help I guess since it’s been so long. My primary concern is evening out my nostril and bringing up that columella. If the tip and nostrils can be defined would be great but I had thick skin and am ok with the way the rest of my nose.

Ali Sajjadian, MD, FACS · Answer

Thanks Stpjcq for your question! It really takes at least 12 -24 months for healing to complete itself after Revision rhinoplasty. Revision rhinoplasty is frequently an option for those who have had rhinoplasty surgeries in the past and are having problems like unequal nostrils and a hanging columella. But given the case's complexity—especially given the history of severe bleeding, the development of scar tissue, and thick skin—careful thought and consultation with a highly skilled revision rhinoplasty surgeon are necessary to fully understand the possible outcomes and the surgical strategy.
The present asymmetry and the appearance of the columella arcould be influenced by the history of severe bleeding and scar tissue. The form and symmetry of the nostrils as well as the location of the columella can be affected by scar tissue's ability to compress and distort the skin and underlying cartilage.  As previously indicated, thick skin can also affect the result of rhinoplasty since it may not redrape over the new framework as readily and can occasionally make it difficult to see the definition of the underlying structures, such as the nostrils and tip. The fact that the prior attempt to lessen scarring with hydrocortisone injections did not result in a noticeable improvement raises the possibility that the scar tissue is thick or mature, making revision more difficult.   
Issues from prior nose operations are especially addressed with revision rhinoplasty. A surgeon may need to release scar tissue, reposition or reshape cartilage, or utilize grafts to fill in missing portions and enhance symmetry in order to fix unequal nostrils. 
In order to produce a more balanced connection with the nostrils, methods for a hanging columella may include cutting the septum shorter, moving the columellar cartilages, or removing extra tissue. Although the main objectives are to smooth out the nostrils and fix the dangling columella, people with thicker skin may find it more difficult to achieve noticeable definition in the tip and nostrils when compared to people with thinner skin. In addition to being more likely to enlarge and create scar tissue, thick skin can make it harder to see minute alterations to the underlying cartilage. Nonetheless, proficient revision surgeons possess methods to improve tip definition in individuals with thicker skin, sometimes utilizing robust cartilage grafting to offer superior structure and support.   A comprehensive consultation with a board-certified plastic surgeon who specializes in revision rhinoplasty is essential.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

Tanveer Janjua, MD · Answer

Your nostrils are not bad but the hanging columella is an issue. It can be pulled back in to reduce the hanging appearance. The procedure is called Columellar Reduction. It is a quick in office procedure done under local anesthesia and take 30min or less.
Regards
Dr. Janjua

Steven M. Denenberg, MD · Answer

The hanging columella does draw some attention, and usually it's possible to *improve* that, but not to reduce it completely. A natural nose is supposed to have some visibility of the columella from the profile, and with even a modest improvement, it's likely possible to get that part of your nose more into a range of normal. I guess I would encourage you to consider elevating the tip at the same time. Some good morphs could show you what that might look like.
Nostril asymmetry on the base view, especially an asymmetry like yours, is just almost impossible to fix, and I would encourage you to de-prioritize that issue. People almost never get to see you from that angle, and even when they do, they're not analyzing your nostril symmetry. Specific work to make the nostrils symmetric might complicate or harm the attempts to get your columella and nose length where you want them, too.
Understand that this would be a complicated operation, beyond the skill of the great majority of rhinoplasty surgeons.

Eric M. Joseph, MD · Answer

Based on your photos, we can see that you have a fairly visible columella incision that is associated with an exaggerated curvature and hang of your columella. Additionally, you appear to have a bit of a long nasal appearance and a droopy tip. If you have severe dissatisfaction with the appearance of your nose, please consider meeting with several reputable rhinoplasty specialists who are expert in revision surgery so you could see what to expect after surgery. Thank you for this question, and I hope it helps you. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. Nostril symmetry could also be improved.   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

Can my nostrils be evened out? (Photos)

Answers (5)

Answer: Revision rhinoplasty for a hanging columella and a droopy nasal tip appearance.

Answer: Revision rhinoplasty for a hanging columella and a droopy nasal tip appearance.

Answer: Revision rhinoplasty

Answer: Revision rhinoplasty

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

Can my nostrils be evened out? (Photos)

Answers (5)

Answer: Revision rhinoplasty for a hanging columella and a droopy nasal tip appearance.

Answer: Revision rhinoplasty for a hanging columella and a droopy nasal tip appearance.

Answer: Revision rhinoplasty

Answer: Revision rhinoplasty

Browse related questions

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.