Should I get revision rhinoplasty? (Photo)

Question

I had rhinoplasty 12 years ago and was very happy with the results. Over time the right side of my nose got a little concave and the original doctor injected silicone 1000 to fix it. I had really good results and am happy. However, he wants to revise the tip as it is slightly asymmetrical. He would not charge me much at all. But he says there is 80% success rate - but is pretty sure of good results. My husband doesn't want me to do it. Not sure if I should - would love opinions.

Randal Haworth, MD, FACS · Answer

I do note that you have a concavity on the left side (the right side of the photographs) which represents a partial collapse (perhaps that's too dramatic a word but that's what we plastic surgeons referred to it as) of your left middle vault. A nasal middle vault collapse/concavity can certainly be helped with injecting filler (as you had done) to correct the cosmetic deformity. However, often times, a middle vault collapse is associated with breathing difficulties which, of course, cannot be corrected with filler alone. That would entail a revision rhinoplasty at which time cartilaginous spreader grafts would be inserted between the septum and the upper lateral cartilage. Also, I feel your tip may be somewhat over projected from the profile view. Filler can certainly help correct this discrepancy between your nasal tip and bridgeso that the tip would not look so projected.All in all, your results are nice. Depending on your goals both approaches are perfectly acceptable-Filler for aesthetic issues only and surgery to correct aesthetic issues and nasal obstruction.

Elias G. Gikas, MD · Answer

The decision to do it is yours.  If it bothers you so much, you should proceed.  Correction of the asymmetry of the tip as well as placing a cartilage graft to correct the depression of the left nasal wall, in experienced hands, should give you good results.

Fred G. Fedok, MD, FACS · Answer

If you have been contemplating this then it would bode well for you to seek a limited number of consultations.  You will have to sort out your "cost-benefit ratio" and decide whether you want to proceed.  I see several nasal features in your pictures that could be optimized, but at the end of the day that decision is yours.  I wish you good fortune and the right decision for you in your quest.

Michael T. Somenek, MD · Answer

Your complaint regarding an asymmetric nasal tip is very common amongst patients who have had rhinoplasty 10-15 years ago. Over time, depending on how much of the underlying cartilaginous structures were resected, this can lead to progressive contracture of the nasal skin. As a result, the asymmetries that are present within the cartilage can become more obvious and pronounced. Your pictures of the nasal tip are not very clear, however, tip revisions can include a variety of approaches. For revisions, cartilage from the septum or ear is usually sufficient enough to create structure and symmetry to the tip. I would urge you to use caution with having filler placed into the nasal tip as there are risks associated with this such as compromising the blood supply to the overlying skin which can cause tissue loss and greater deformity.

Kris M. Reddy, MD, FACS · Answer

Revision rhinoplasty should be a patient's choice. If you are not motivated to have the surgery, do not proceed. Your surgeon seems to have outlined your options well.

William Portuese, MD · Answer

The decision to proceed with performing a revision really depends upon the patient, not the surgeon. If the tip of the nose and the concavity on the sidewall bothers you a significant amount, then undergo the procedure. in our practice, we placed a spreader graft underneath the concave upper lateral cartilage to help with the concavity. Make sure that your surgeon is very experienced in rhinoplasty and revision rhinoplasty surgery.

Jeffrey Epstein, MD, FACS · Answer

What I tell all my patients is that if you are happy and satisfied with the results of a prior surgery, I do not recommend taking the small but definite risk that revision surgery carries.  Of course, my willingness to do a revision rhinoplasty is quite high, as I do feel that in my hands there is a quite low risk of complications, and done properly even if conservatively, the results can be noticeably improved- in your case, restoring symmetry to the tip and slightly setting it back, and if indicated, filling in what is a slight depression on that right side.

David Reinstadler, MD · Answer

Any cosmetic procedure needs to be something YOU want to do. I would never recommend proceeding with surgery if my patient wasn't 100% excited. It is also important to have family support but in the end, it is a decision you need to make.. I always weigh the risk/benefit - if you are currently happy with your nose, will you be 'happier' after surgery? If he said there is approximately an 80% 'success rate' is it worth a 20% possibility of no improvement? Best of luck

Richard W. Fleming, MD (retired) · Answer

That is your decision. It sounds like your surgeon explained what can be done and risks involved. My opinion is irrelevant. Best of luck.

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