What can be done to reduce the amount of scar tissue 5 years after a revision rhinoplasty? (photos)

Hello and thank you for your question. Based on your photographs, you may benefit from a revision rhinoplasty. This could be designed to help improve your nostril symmetry and correct alar retraction and decrease the columellar exposure. 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

Based on your photos, I do not believe you are having a problem with excessive scar tissue. You appear to have a very thin nasal skin and it has shrunk down to the underlying cartilage of your nose. The most asymmetry is seen in your base view, and this is the least important view. Please consider re-asking you a question so it's clear what you are unhappy about with your current initial appearance. Thank you. Sincerely, Dr. Joseph

Hello and thank you for your question.

The short answer for treatment of scarring 5 years after a revision rhinoplasty is... another revision rhinoplasty.

As for the long answer...

Although an exam in person is ideal, from your photographs alone it is unlikely that further steroid injections will make a significant difference when you're 5 years postop.

I'll preface the following by saying that all surgeons have complications, especially from scarring. Any surgeon who doesn't, is either not doing enough rhinoplasties to know, is not following up patients long-term, or is lying... With that said, the question to ask is what bothers you the most. From your photographs, I see a few issues that may be addressed if they're truly important to you...

(1) The subtle widening from the AP (front) view: a revision rhinoplasty can address this by debulking the upper third, the mid-vault (middle third), and tip complex with postop steroids started early in your recovery period.

(2) The increased alar-columellar (nostril) show from the lateral (profile) views (right more than left):
this would be best addressed with extended spreader grafts and extended alar contour grafts. Since your septal cartilage was already harvested from your prior rhinoplasties, I would utilize Musculoskeletal Transplant Foundation (MTF) aka cadaver cartilage grafts to perform your revision.

(3) Loss of tip defining point (subtle upturn at tip) from the profile view: the scarring along the midvault and tip is likely preventing you from having a tip-defining point. This would also be addressed with subtle dorsal mid-vault reduction, debulking at the tip, MTF cartilage grafts, and I would also add mastoid fascia (tissue from behind your ear, about the quarter the size of a postage stamp) to place as a tip graft to further refine your tip.

(4) Nostril asymmetry from the worm's eye view (bottom of the nose) view -- MTF grafts to your ala (nostrils) and columella (skin between your nostrils) would address this asymmetry.

Another issue that may reoccur is breathing difficulty. Your deviated septum may have recurred or you may have internal nasal valve collapse. These issues can be addressed with a revision septoplasty and spreader grafts, respectively.

The next step for you is to address these (or any other) concerns directly with your plastic surgeon. Again, please recognize that scarring complications can happen to anyone...

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Not much can be done about removing scar tissue. The photographs demonstrate a hanging columella and wide nasal bones. If those two issues bother you, then consider a revision rhinoplasty to reduce the hanging columella and narrow the wide nasal bones. The scar tissue will remain the same.