Do These 3 Different Plans for Secondary Rhino Sound Reasonable? How Do I Choose? 10 Months Post Open Septo-rhino (photo)

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?

Doctor Answers 4

Choosing the best approach for secondary rhinoplasty

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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.   

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 reviews

Revision rhinoplasty

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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

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Rhinoplasty revision

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Some form of drosal augmentation sounds reasonable, I would avoid implants that are not made from cartilage.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Revision rhinoplasty

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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.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.