How can a step-off deformity be corrected (without fillers)? Primary Closed Rhinoplasty done 5 months ago (Photo)

Question

I'm unhappy with the results of my primary rhinoplasty. Then I noticed a step-off deformity along the sides of my (bony) bridge. The surgeon performed lateral osteotomies at the base of the nasal bones (very close to the face), I still remember two little scars from the incisions there. But it also seems that he used very high intermediate osteotomies (far from the face), leaving a step-off on both sides! How can this be corrected?? What if they were performed along the nasomaxillary suture??

Ivan Wayne, MD · Answer

I am sorry to hear about your issues following rhinoplasty
surgery. I would always advise patients to bring their concerns up with their
surgeon first. As to the issue of deviation after surgery I would say that it
appears you have some loss nasal dorsum projection. I would need to see pre-op
photos to really say what is likely to be going on.Good luck and I hope this helps you.Dr. Wayne

Manish H. Shah, MD, FACS · Answer

Hello Zoneth,Thanks for your question.Unfortunately, if you need nasal bone fractures (osteotomies) for bridge narrowing or to close an open roof deformity, you get a normal edge transition.  It will be months until it smoothes out more, but it will never disappear.  If you get injectable filler to "hide" it, you just widen again which throws off the aesthetics.If you simply can't deal with it, you will need to wait until one year post-op to have revision work.  The revision work that will help but won't be perfect would be to place soft tissue filler over the bony edges to soften the transition visually.  ADM, acellular dermal matrix, like Alloderm can help in this regard.Trying to move the osteotomy sites closer to the nasomaxillary suture might help but may also cause a hollow sensation in the nasal sidewall on palpation.Consulting with a revision rhinoplasty specialist might help you better decide on your options.Good luck,Dr. Shah

William Portuese, MD · Answer

Revision rhinoplasty is  a very difficult endeavor, and the nose is a three-dimensional structure, so a full internal and  external examination of the nose is required for making any determinations about revision osteotomies. Depending upon the placement of the osteotomies, they may need to be repeated and placed in a lower position. For more information and many examples, please see the link and the video below

How can a step-off deformity be corrected (without fillers)? Primary Closed Rhinoplasty done 5 months ago (Photo)

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