Revision Rhinoplasty: what can be done to fi my wide mid vault and bump? (Photo)

Question

I had surgery in 2015 and a revision in 2017 by the same doctor, unfortunately the end result is not what I had hoped for, my mid vault still seems wide, I have a small bump on the left side, the tip was supposed to be a “tip”. I feel like I have a nose that does not compliment me. I am looking to a revision to have a nose that suits my face and any suggestions or recommendations would be greatly appreciated.

Steven M. Denenberg, MD · Answer

I'd love for you to see some excellent morphs of what could possibly be done with your nose. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. 
Remember also that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, requiring skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Nima Shemirani, MD · Answer

Hi @Sociable5621! I recommend seeing an expert revision rhinoplasty specialist for an in person examination. There are several options for you that can be determined after examination. During surgery the area can be smoothed over with the help of piezo surgery and other techniques. A rhinoplasty in my opinion is one of the most difficult procedures to perform. In my practice, I utilize piezosurgery. Piezosurgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezosurgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures. Best of Luck, Dr. Nima!

Suleyman Tas, MD, FEBOPRAS · Answer

Hello, thank you for the question and provided information, photos overall shape of your face would help more.  A well- executed rhinoplasty procedure can improve your function and apperance of your nose significantly. However, there is always a finite limit about how much a nose can safely be changed. You need to seek a professional, exprienced surgeon. You can benefit from closed technique that provides maximal healing and eliminates a scar across your columella.Best Regards,

Toby Mayer, MD · Answer

Revision rhinoplasty for correction of nasal bones and mid vault.  A thorough examination and evaluation of skin bones and or underlying cartilage needs to be done  before a surgical plan can be formulated. See several very experienced revision rhinoplasty surgeons who can show you many results of their work  with revisions similar to yours and worse.

Curtis Perry, MD · Answer

There are a number of options to improve the appearance of the nose in revision rhinoplasty. The specific surgical plan is based on a careful examination and history.

William Portuese, MD · Answer

Revision rhinoplasty is more difficult than a primary rhinoplasty. Since this will be your third rhinoplasty, a thorough internal and external examination of the nose  will be required to make a determination about whether or not you're a good candidate for the procedure. With 2 prior  rhinoplasty procedures, there's going to be extensive scar tissue and previous alterations to the normal anatomy. The dorsal hump can be shaved down, while medial and lateral osteotomies are usually performed to narrow the nasal bones and mid-vault.

Revision Rhinoplasty: what can be done to fi my wide mid vault and bump? (Photo)

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