How can a caved in nasal bone be fixed with revision rhinoplasty? (Photo)

Question

During my primary rhinoseptoplasty in 2015, my left nasal bone sunk in more than my right when my surgeon broke my nasal bones. I used to have decent contour of my nasal bridge and both of my nasal bones sat even. Now my left nasal bone is sunk in and my right one appears to be too far out. Can this be fixed? Is it a difficult procedure? Can it be fixed by simply pulling my left nasal bone back up without grafting?

Alejandro Nogueira, MD · Answer

I think I understand what caused this problem: uncontrolled vertical fracture of the left nasal bone.You had a small and not very prominent dorsal hump >>> the surgeon shaved just a bit of dorsum >>> the nasal bones did not freed from each other and a synostosis (bone fusion) between them and the septum persisted as a solidary block, aka "closed roof", same as prior to surgery but a bit slimmer >>> until here all is correct, however at this point, when you detect solidary nasal bones, no osteotomy should be attempted without previously relasing the synostosis between the nasal bones, which is best accomplished with the manual Joseph's saws or alternatively (when too large synostosis) under chisel work; since the "roof is open" then osteotomies can be performed safely and efficiently >>> however your surgeon stayed unaware of the closed roof solidarity, which was assymmetrical (happens commonly) affecting only to the left nasal bone cojoined with the septum (left closed roof and right open roof), and he tried the osteotomies, the right one went smoothly but the right one, due to the synostosis, was incompetent all the portion of solidary synostosis and effective below the solidary portion, at which the nasal bone broke from dorsum to maxilla and pinching that area in an unwanted line of fracture (instead of breaking at the radix, as is intended).Solution now is unclear by the images, but for sure needs a very very very good revision rhinoplasty surgeon, refracturing, eventually grafting (spacers) or chiseling the dorsum, temporal fascia graft as camouflage, etc.I notice other issues at other parts of the nose, like pinching of alr cartilage, tip shape issues, etc.If you wish better grounded opinion please do post or send privately well lit, focused and standard images: frontal, both lateral and both oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

William Portuese, MD · Answer

Revision rhinoplasty is more difficult than a primary rhinoplasty, so it's very important to choose your surgeon based on extensive experience straightening crooked noses. The  nasal bones are straightened with placement of osteotomies in them. The midportion of the nose is treated with a spreader graft placed underneath the concave upper lateral cartilage in the midportion of the nose which is demonstrated in all of the photographs. The nasal tip itself also appears to be somewhat crooked in some of the photos may need to be addressed as well. There is no perfect nose, just improvement. For more information and many before-and-after examples, please see the link and the video below

Steven Wallach, MD · Answer

Your deviation may be more than just bone. Your middle vault may be involved as well. Best of luck...

David L. Cangello, MD, FACS · Answer

Hello and thank you for your question. If the nasal bone is deviated medially it can be refractured and displaced outward. But it appears (taking into account the limitations of the photos), the middle vault left upper lateral cartilage is collapsed. This can be fixed with placement of a spreader graft. Hope this helps.

Fred J. Bressler, MD, FACS · Answer

There does appear to be some concavity to the left nasal bone and upper lateral cartilage in your photos. In general, correction  requires a revision with spreader cartilage grafts and possible osteotomies. An experienced rhinoplasty surgeon should be able to determine the best revision approach after a complete examination and review of your prior surgery operative reports and photos. If your middle vault dorsal aesthetic lines really bother you, in my view, it would be worthwhile to consider revision. Best wishes.

How can a caved in nasal bone be fixed with revision rhinoplasty? (Photo)

Answers (7)

Answer: Collapsed upper nose cartilage

Answer: Collapsed upper nose cartilage

Answer: Nasal Dorsal Deformity after Primary Rhinoplasty

Answer: Nasal Dorsal Deformity after Primary Rhinoplasty

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

How can a caved in nasal bone be fixed with revision rhinoplasty? (Photo)

Answers (7)

Answer: Collapsed upper nose cartilage

Answer: Collapsed upper nose cartilage

Answer: Nasal Dorsal Deformity after Primary Rhinoplasty

Answer: Nasal Dorsal Deformity after Primary Rhinoplasty

Browse related questions

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.