Would a 2nd revision rhinoplasty be beneficial for me given my thick nasal skin and previous negative experiences? (Photo)

Question

I had a septorhinoplasty 2+ years ago to mostly reduce a bulbous tip. however,post op my nose was crooked (wasnt prior to all this) and so in dec 2014 we did a revision to try to cut out any scar tissue and straighten it. almost a year out from my revision and my nose has formed even more scar tissue and is more crooked than before. my dr has done kenalog shots this time but has mentioned a 2nd revision. does this sound like a waste of time given ineffectiveness before or is it realistic?

Alejandro Nogueira, MD · Answer

I am afraid you are chasing an impossible goal: symmetry; your nose is not crooked anymore, it is just assymetrical, one side is smaller so the pyramid leans to that short pillar; no surgeon may achieve correction of this.Leave the nose.

Jonathan Pontell, MD, FACS · Answer

Hi and thanks for your question.  I expect that your septum is deviated and is pulling your nose to the left or you have some significant asymmetry to your nasal tip cartilages that is pulling your nose to the left.  Each of these issues can be addressed with a revision.  Revision surgery is more difficult then the primary surgery, but you can still get the nose that you want.  You need to go to a surgeon with lots of revision and primary rhinoplasty experience, not the average plastic surgeon who may do 15 noses each year.  Good luck.

Steven Goldman, MD · Answer

It can be stressful to contemplate revision. Tooptimize the chances of definitively correcting all of your concerns, the surgery has to be planned with precision. Based on your pictures (not a formal consultation), your nose may benefit from repeat osteotomies (rebreaking) and a spreader graft (a graft of your own cartilage in the mid-portion of the nose)--because the upper and middle third are deviated. The tip and columella (the skin in the middle between the nostrils at the bottom of the nose) are also deviated. Correction likely involves adjustment of the bottom of the septum, possibly adjustment of previous cartilage grafts, and revision of sutures in the tip cartilages. Ear cartilage grafts may be necessary if there is not enough residual septum for grafts. You are doing the right thing by researching the procedure and asking questions. Good luck.

Bahman Guyuron, MD · Answer

Two conditions would cause a tip deviation like this. The most common condition is the deviation in the bottom portion of the septum which has shifted off the natural platform and the second is a columella strut (a cartilage graft within the column between the nostrils) that is dislodged to one side and pushes the tip to the opposite side. Your nose can be made more elegant with some refinements such as adjusting the nostrils that are uneven, the right side being higher and wider, placement of alar rim grafts, narrowing and repositioning of the tip structures and possible adjustment of the septum.

William Portuese, MD · Answer

A full set of photographs are required of the nose to make any determination about what may or may not be required. Since a tertiary rhinoplasty for a crooked nose is A very difficult procedure, an in-person consultation and examination is required to discuss options. There are mltiuple techniques that can accomplish straightening the crooked nose such as osteotomies placed in the nasal bones, a unilateral spreader graft placed on the concave side in the midportion of the nose, and a tip rhinoplasty to adjust the crooked nasal tip. Best to obtain the old records to find out what was accomplished in the first 2 rhinoplasty procedures.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,In order to refine your bulbous tip, not only should scar tissue be removed but cartilage grafting is also important to add structure to the tip. A revision should solve this problem, you just need to find the right surgeon.Best,Dr.S.

Would a 2nd revision rhinoplasty be beneficial for me given my thick nasal skin and previous negative experiences? (Photo)

Answers (6)

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