Cleft rhinoplasty - Could a rhinoplasty alone help improve the symmetry and overall appearance of my nose? (Photos)

I don't believe the nostril asymmetry is due to the intubation; it is true that prolonged endonasal intubation may produce pressure sores and skin necrosis with the ensuing scarring and constriction (narrowing in circunference or in a notch), but... that's not visible in the photos posted, I am not denying the intubation played a role in that problem, I am saying I don't see signs of that in the images, so take this with a grain a salt.

However, that right nostril belongs to the side of the cleft (unilateral, complex for involving palate and right sided, I understand this was your diagnosis), and practically all adults with unilateral cleft have that nostril hypoplastic, smaller, rounder (your case) or even horizontalized with a flad hemitip (not your case, though).

Additionally, your nose grew like a "tension nose", which I believe is a familiar and ethnic trait and not due to the cleft lip. That peculiar name refers to a type of nose in which the pyramid, the hump, the nasal bones and the triangular cartilages are overdeveloped, this is too large, however there is a constriction at the skin cover and the cartilages forming the lower third of the nose (tip, alae, columella, infratip, etc.). In your case the "tension" due to the skin deficit is aggravated on the right half of the lower nasal third because of the cleft lip and its repair, thus creating this concerning zigzag look you show. That's why when you pull your tip the upper lip comes conjoined.

This tension nose is a very difficult and tricky type of rhinoplasty, the surgeon has to weaken and reduce the upper two-thirds and at the same time reinforce and eventually augment or at least over support the lower one-third, by means of powerful grafting within structure rhinoplasty.

Normally, in a standart tension nose case, the method to overcome to the skin deficit is using strong cartilages and powerfully expanding neo-structure so that the skin is molded and increased by physical action of the new skeletal frame, after few months or even more than 1 year the set is stabilized.

Only once in my career I had to apply a (basic) maneouver (zetaplasty) to supply some skin at the columellar base in order to allow the suitable expansion of the tip (it was an extreme tension nose case, you can see it below at the link, find the my case nº R83DCEDW or just google this charset). However, you have congenital and postsurgical factors making more than likely more advanced skin cover supply maneuvers that allow the new skeleton to surface and not be "under tension" again; to be assessed by an in person evaluation, but for sure you a going to need it, and not for being a post-cleft lip case, but for the combination of a cleft lip (source of skin shortfall) and tension nose (additional source of such).

Read at the link below to know more about tension noses and their treatment, also some images of real cases.

My advice is you seek the help and advice of a surgeon with solid experience in tension noses, given that your nose is mainly and mostly that type of challenge; in any case a good structure rhinoplasty surgeon can satisfactorily manage any adult post-cleft-lip rhinoplasty case. One additional comment, in this congenital cases is sometimes recommendable or necessary using atypical surgical approaches to the nose, again it all depends of the in person assessment.

I don't forget about the crookedness of your nose, that also has to be addressed to the highest level of correction possible, which is rather high but, be realistic... it won't be a total straightening but a very good one.

We have taken care of many people over the years with cleft lip nasal deformities. Based on what I see from your photos, you appear to have a long and crooked nasal appearance, with a droopy tip, and nostril asymmetry. I believe it is important to seek an opinion from a specialist, since your case will be difficult if there was previous surgery performed when you were a baby. Goals of surgery may be to provide a straighter, smaller, less distracting, and better breathing nose. I hope this helps! Sincerely, Dr Joseph

Yes, a rhinoplasty would make a marked improvement. Your nasal columella angle is quite poor. It should be at 90 degrees and it appears to be less than that. Also, your dorsum is not straight. You do have asymmetrical nostrils that may remain after surgery because they are the most difficult thing to correct.

Best Wishes,

Gary Horndeski, M.D.

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon