Is this an easy fix without surgery? (Photo)

Question

I'm not sure if this assymetry can be corrected by a small closed revision or fillers. At first I wanted to raise the lower nostril but the more research I do, I realize it might be easier to lower the higher nostril. I'm good with either scenario, just need a more symmetrical outcome! Thought?! This is after an open revision by the way.

Jason Emer, MD · Answer

Hello and thank you for your question. You have a very difficult problem to fix. It sounds like your biggest concern is your asymmetric nostrils after your surgery. This is due to asymmetric alar retraction, which can unfortunately happen as the scarring after rhinoplasty contracts the nasal alae vertically, as in your case. There are certain maneuvers which can be performed during rhinoplasty surgery to prevent such retraction. Given you've previously had a rhinoplasty, and there is no doubt extensive scar tissue present in your tip and alae, fillers would not be able to overcome the scarring, and only an open rhinoplasty can best address your issue.

In addition to addressing your aesthetic concerns, your septal cartilage (or an off-the-shelf alternative) would be harvested (removed) and turned into multiple cartilage grafts, which would then be secured into different areas of your nose for structural support, including in the columella (middle bottom portion of your nose between your nostrils) to really reinforce the tip and alae, and prevent recurrence of the alar retraction. As you've already had a rhinoplasty, likely your septal cartilage has been used already, so we'd use an off the shelf alternative (MTF cartilage).

The open approach is very effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery. I would only recommend going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible.

Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos and description provided.

Dr. Donald Groves, our expert facial plastic surgeon, has extensive training and experience with complex rhinoplasty surgeries, so I’d recommend for you to come see him (or another plastic surgeon who is extremely comfortable with rhinoplasties) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Emer

Eric M. Joseph, MD · Answer

If you would be happy with lowering your left nostril so it's the same height as your right, microdroplet Silikon-1000 injections may be considered depending on your examination. I hope this is helpful and thank you for your question. Sincerely, Dr Joseph

Is this an easy fix without surgery? (Photo)

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