Looking for doctor for revision rhinoplasty for c-shaped deformity & amorphousness

Question

Specifically I want to know 1) revision rhinoplasty surgeons that can fix my crooked nose w/o making it look fake I’m pretty sure I need a reverse osteotomy & grafting. I want a doctor that has an aesthetic ideal of a high point on the bridge & understands the subtle curvature of the bridge. I don’t want a parallel nose like the bad examples I attached. 2)What would you do to my nose to improve it? 3) Can my nostrils be more finessed w laser?

Alejandro Nogueira, MD · Answer

After studying your images I have few comments based on my experience with revisions:-to be honest I don't see some of the deformities you are mentioning, I agree your nose is a very very poor result and gather multiple technical errors and misjudgments, but maybe you are being over critical to a point of perceiving unreal deformities; your deformities are pretty clear and of course they do need revision; I'll list them below and potential solutions-You don't need reverse osteotomy, among other reasons... beacause such thing does not exist; and secondly because your open roof deformity and your nasal bridge deformities and ridges are due to... exactly! failure to perform complete and symmetrical osteotomies, for some reason the surgeon made only unilateral infracturing, and additionally the one side fracture was performed too high and outside the canonical placement at Joseph's angle between nose and maxilla; you need revision of the osteotomies and closure of the open roof; also this asymmetry in the performance of the osteotomies is the main cause of your crookedness (has solution, thus) plus your natural asymmetry (no solution about this, ever).-As consequence of the previous problem the middle vault is collapsed and needs, likely, spreader grafts, pretty standard in this kind of revision rhinoplasties.-The tip is virgin, nothing has been done about its issues: over projection, bulbous oversizing, bifidness, position, etc; needs primary structure rhinoplasty work done on.-Seems to me the supratip is hollo and shows saddle depression, if this is confirmed a graft may be required to level the dorsum.Additionally to the former, if you wish any kind of customization, like seeking similar look to certain wish models of noses, then you not only need a good REAL revision rhinoplasty, but also a surgeon with customization skills.Difficulty 7 out of 10 in revision rhinoplasties, surgical time about 4 hours.See the link below to find few cases of my own practice very similar to yours which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted.
If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views, also from underneath.
Feel free to request any additional information from me.

P. Daniel Ward, MD · Answer

thank you for your question. I think that your goals can certainly be achieved through a revision rhinoplasty.  In addition to working on the dorsum of the nose, I think that addressing the tip width, the tip under rotation, and the tip projection will be important.  I would plan on addressing your nostrils of the time of surgery. Based on the photos, I cannot tell if laser would be helpful or not. Please let us know if you have any other questions or concerns!

William Portuese, MD · Answer

Revision rhinoplasty is much more difficult than a primary rhinoplasty due to the fact there is previous alterations to the normal anatomy, and scar tissue formation.  It also very important to have realistic expectations about what can and cannot be accomplished with the procedure to give the natural look.  This straightened the crooked nose requires medial and lateral osteotomies and placement of a spreader graft on the concave side. For many examples, please see the link and the video below

Looking for doctor for revision rhinoplasty for c-shaped deformity & amorphousness

Answers (3)

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