Can a second revision rhinoplasty fill in the indent on the side of my nose? Or is it risky? (photo)

Question

I had my first rhino in 2018 and he removed too much. I had a revision in 2019 but the doctor did not fix my indent/caved in appearance from the first surgery. I also have breathing issues on this side. Can a graft be used to pop up that side to be like my left side? On the photo the indent shows on the right side. Is a third surgery to fix this really risky? Or can I get the results I desire? Will it help me breathe better as well? Thanks!

Nima Shemirani, MD · Answer

Hi @pjannahx! Thank you for sharing your photos. I recommend seeing a revision rhinoplasty specialist for in person examination. There are several options for you that can be determined after examination. A rhinoplasty in my opinion is one of the most difficult procedures to perform. In my practice, I utilize piezosurgery. Piezosurgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezosurgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures. Best of Luck, Dr. Nima!

Andrew Miller, MD · Answer

Based on your photo, you are a candidate for revision rhinoplasty. Some patients will try a filler injection first to see if it accomplishes the desired effect. But if not, a properly placed cartilage graft can both improve the shape and help the breathing. Be sure you see a rhinoplasty expert for consultation.

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photo.

I am sorry that you have experienced difficulties with your surgery. In the first instance, I suggest discussing your situation with your surgeon. They may be able to offer simpler solutions than when you have surgery in a new centre.

The photo suggests an asymmetry of the tip cartilages with underlying problem being a slight deviation of the support of the tip to the right (if the image is mirrored). This is associated with stronger folding of the right tip cartilage and as a result the supra-alar crease on the right is deeper and the airway would often be more restricted at the entrance. A photo taken from below can give more information on this point.

A consultation in person would be required to evaluate the area of restriction for the nasal airway since the external appearance can be deceptive.

The cosmetic aspect can be addressed with injectable filler or with cartilage graft but if you look at correction of the airway as well as shape, it may be necessary to adjust the alignment of the tip of the nose and re-do the shape of the nasal tip domes. Grafts are likely to be needed to this effect but this depends on the strength of the support already in place and whether it can be adjusted.

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Afternoon! I see what you're referring to in your photo. Yes, grafts can be used to improve the appearance and function of the nose. I prefer septal cartilage but will use other sources like ear or rib. If too much was removed, that can leave the indention and subsequently affect breathing as you've noticed. By placing a graft carefully, you can get nice improvements. Anytime a revision is performed, there is increased risk for things like infection or creation of other asymmetries, though hopefully low. If you haven't already, seek consultation with a facial plastic surgeon proficient in revision rhinoplasty. Hope this helps you!

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