Revision rhinoplasty and the still crooked nose
Hi, thank you for submitting your photo, sorry things have not turned out the way that you would like. From what I can tell there seem to be 2 components that may be contributing to your nasal assymetry or crooked appearance. First, the bone-cartilage pyramid or bridge of your nose appears to be shifted with a straight line deviation off to the right side of your face. Second, the middle third of your nose seems to have some excessive tissue further contributing to protrusion on this side and this may indeed be a 'spreader graft' of cartilage which is commonly placed to correct a collapsed upper lateral cartilages. You are 11 months down the line from your revision surgery and likely things will not change much beyond this as virtually all of the swelling has subsided.
If you are unhappy and want things further improved, you need to balance the pros and cons of a second revision rhinoplasty. The more revision procedures performed in a given patient, the more difficult it is to predict the reponse of the skin and soft tissue envelope ... eventually this will become the limiting factor. In other words, expectations following revision rhinoplasty need to be lower than with primary rhinoplasty. It may be possible that definite improvements are still possible with minimal risks but only an experienced revision rhinoplasty surgeon can answer that for you. In crooked noses, revision surgery can range from simple such as camouflage grafts to very complex where the bone - cartilage framework is completely revised with osteotomies and grafts.
Perhaps revisit things with your current surgeon as he knows your nose best but also seek out other opinions.
The swelling after revision rhinoplasty can take up to 18 months to settle down. Then again after 11 months, as in your case, one would expect much of the swelling to have settled. A septal deviation (crooked nose) can be quite difficult to fix as the cartilage often tends to have a 'memory' and deviate back to some extent to the original position. Overall, I would suggest to allow it some more time.
Revision Rhinoplasty: Nose still crooked
It is difficult to assess you overall nose with only one view and a blurry photo, but swelling after a rhinoplasty can last up to 18 months depending on the technique (open vs closed). After 11 months, however, the majority of your swelling should be subsiding and the "protrusion" might be the cartilage graft placed by your surgeon which could make your nose appear crooked.
Noses that twist to the side can be improved by asymmetrical "spreader grafts"
A nose that is only deviated form the front has a deviated septum. The grafts may have made it more noticeable, but your septum is tipped toward your right.
"Spreader grafts", described more than 25 years ago by Sheen, will help to align the septal edge and will improve your airway (doubling it, according to my published airflow studies).
Your nose can be made even straighter by placing a thin piece of cartilage over the top of your bridge, not raising it but hiding the crookedness. I do this all the time.
Find a surgeon whom you trust and who can show you results of other patients with similar deformities that you like.
Your nose may get a bit thinner but it will likely stay deviated. As others have said it is important to diagnose the cause of the deviation.
After revision rhinoplasty
Your photos show a significan asymmetry. This is not likely to change much after 11 months. Discuss this with a surgeon who is comfortable with revision rhinoplasty, since these are much more difficult than primary cases. Donald R Nunn MD Plastic Surgeon.
You still have swelling but it does appear that you still may have some deviation present or recurrent. Your face may also be asymmetric as well. Revision noses with deviation are among the hardest to fix. See what your surgeon thinks about your progress and if you might need further work.
Revision rhinoplasty with persistent crookedness
After 11 months if the nose is still crooked I do not feel it will straighten appreciably in the next several months. There still may be swelling that needs to go down but probably not enough to straighten the nose. It could be that the septum is still deviated or that the valve on the left is collapsed. You probably need to have the internal nasal airway evaluated as well as the external structure. Without seeing your pre-revision photos it is difficult to know how much progress has already been made. Sometimes with revision surgery all cannot be done in one surgical setting.
Nasal deviation after rhinoplasty
The area where cartilage was grafting to repair the nasal collapse may take over a year to settle out.
From your photo your nose seems to deviate to your right. It's hard to tell if this is because your head is turned slightly or if this is related to an overall facial asymmetry (in which case a perfectly straight nose may not go well with the rest of your face).
I'd recommend dicussing your concerns with your surgeon.
Crooked Nose after Revision Rhinoplasty
I know you want to maintain privacy, but it is difficult to evaluate your nose without seeing your eyes and brows. Your nose may be crooked or you may have nasal asymmetry. Swelling can improve in your bridge, but after 11 months it is reasonable to have an evaluation to determine if another revision is necessary. See an experienced revision surgeon.