Can these irregularities be fixed? (Photo)

Question

I had a rhinoplasty over a year ago. The tip of my nose was left with a mass on one side and I feel a pointy bone or cartilage on the same side. I also have uneven nostrils. I asked my surgeon and I was told that there wasn’t much he could do. I was wondering if I should get a second opinion. I feel defeated. I have thin skin and I’m scared of getting a revision and bringing more damage to my nose.

Steven M. Denenberg, MD · Answer

It appears, from the little information that these photos provide, that one of the problems is that your left and right tip cartilages are asymmetric, with the left cartilage more prominent. In general the *more* we want to change something in a revision, and the more things we want to change, the more likely it is that we get an outcome that the patient thinks is nice. In your case, there are some clues that the tip is still strong in its forward projection away from your face, and perhaps that the bridge is still a bit high as well. If those features are changed at the same time, it gives more opportunities to correct the kind of asymmetries that you've pointed out.
How *much* to deproject the tip, or lower the bridge, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember 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, and 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 it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Stephen J. Pincus, MD · Answer

I am sorry that your postoperative result is causing you much grief. It appears that the persistent left tip deviation is resulting in some, if not all, of the nostril asymmetries as well as the "mass" you see. You would best be served by getting a second opinion from surgeons with experience in revision rhinoplasty. The problem may possibly be corrected by correcting a deviated septum or asymmetric lower lateral tip cartilages. Plus, I would definitely not accept the fact that there is not much that can be done! On the contrary, I have seen much worse results significantly corrected. So do not feel defeated!!

Eric M. Joseph, MD · Answer

You are correct that many of your irregularities are due to the fact that you have very thin skin. That said, depending on your examination, revision rhinoplasty surgery may be considered for achieving a more symmetrical and less distracting nasal appearance. Please consider Consulting with several reputable rhinoplasty specialists who or for computer Imaging so you could see what might be best for you moving forward. I hope this helps!

Jeffrey H. Spiegel, MD · Answer

Yes - you can get a revision rhinoplasty to shape the cartilage better.  I can see what happened and how the cartilage has gotten. You should be able to get a substantial improvement.

Can these irregularities be fixed? (Photo)

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