Revision Rhinoplasty for S shaped nose. Any suggestions? (photos)

Question

I have gone through a primary open rhinoplasty and have had minor fillers to cover up some of the exaggerated curving in my nose. Though its significantly better than before. I'd love to just make my nose straight. I have an S shaped septum post surgery for about two years. I'd like some opinions about getting a revision. I personally hate the elongated appearance my nose puts off due to its crookedness. Mainly front view I feel as if my nose is really crooked.

Steven M. Denenberg, MD · Answer

See the "Web reference" link, just below my response. I made a couple of computer morphs of your nose, and a animations of the morphs, to show the changes that are possible for your nose in truly expert hands.Mostly, I elevated the drooping tip of your nose. The shape of the tip cartilages makes them look like they point down excessively. It can be hard to correct asymmetries on any nose, but when we make a nose shorter, it gives us more techniques to help with the asymmetries. Any asymmetries tend to look smaller when the whole nose is smaller. Also, if the length of the nose isn't drawing attention, the asymmetries don't draw as much attention. And for example, in that first photo, where you are looking a little down, we see that much of the asymmetry is at the tip. If we have the opportunity to move the tip up, we can do a better job of moving the tip to the center as well, helping to correct the asymmetry.

You should understand that the changes I demonstrated in the morph require very advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a revision rhinoplasty surgeon, and how to tell whether you should let your primary surgeon perform your revision.

Your nose is also a good example of why computer imaging 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. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.And don't use any more fillers in your nose. Fillers are okay for tiny changes, but only if you know 100% that you're not going to have any more surgery on your nose.

William Portuese, MD · Answer

Since it is been at least a year since the primary rhinoplasty, a revision can be contemplated. It's important to know how much cartilage is left on the inside of the nose for potential grafting purposes. The nose can be shortened and straightened and made more symmetrical, but it may never be perfect.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,There are many reasons for an S shaped or curved nose. The revision may require simple cartilage camoflouge grafts or more extensive spreader and strut grafts.Best,Dr.S.

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