Doc 1: Osteotomies, silastic implant to raise bridge & push tip down, lower alar rims, spreader grafts. Doc 2: No osteotomies, rib to raise bridge & push tip down, lower alar rims, add cartilage to tip to make it look lower, spreader grafts. Original doc: No osteotomies, spreader grafts, mid 1/3 slightly wider, build bridge with septal/ear cartilage, lower alar rims, says higher bridge will give illusion of length & blend tip, no tip derotation. Says rib too aggressive. I'm so scared. Help?
Do These 3 Different Plans for Secondary Rhino Sound Reasonable? How Do I Choose? 10 Months Post Open Septo-rhino (photo)
Doctor Answers 4
Choosing the best approach for secondary rhinoplasty
Based on the photos it appears that your tip is over-rotated and counter-rotating it (pushing it down) would improve the appearance of your nose. Simply augmenting your dorsum (building up the bridge) without addressing the tip rotation will cause your nose to look short. I would advise against using a silastic implant. Out of the 3 options, the one with rib is most likely to give you lasting results you are happy with.
Best to use nasal cartilage to build up the bridge, which will help de-rotate the nose. Composite grafts to the alar rims will bring down the alar notching. Osteotomies will be needed to narrow the nasal bones and help augment the bridge. Revisions like this one are very tricky, so seek out a very experienced rhinoplasty surgeon
Some form of drosal augmentation sounds reasonable, I would avoid implants that are not made from cartilage.
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All three seem to be heading in the same direction. I would try to use septal and ear cartilage before rib if possible unless you need a lot of support. Only your original doctor will know if you have enough septal cartilage left to accomplish the task.