Too Much Removed from Bridge? (photo)

Question

Wanted tip work done. PS said have to do bridge work bc tip & bridge will not be balanced. Morph pix bridge was so slightly brought down. But post surgery, bridge is going downward unnatural look. Was sugeon not skilled or is this an ugly style? very bad painful recovery. I lost my look bc this new nose is completely different from old. My question, Does it look like too much bone work was done and is this dangerous in means of collapsing/ weak bones in future? Could I have just done my tip?

Anita Patel, MD, FACS · Answer

It is true that the bridge and tip need to be balanced, and the shape of each influences the overall proportions and look of the nose. I agree that typically when you want tip work, the dorsum also needs to be addressed to make sure there is balance and harmony. Unfortunately based on the photo the balance appears to be lacking.To analyze a nose thoroughly, one also needs to see more of face such as the eyes and chin. Based on what I can see, the nose can definitely be improved with augmenting the dorsum and refining the tip. I am not sure if this is soon after surgery and swollen, or if this is your final result. I tell patients to wait a year after the initial surgery to allow for swelling to resolve. I think a good first step for you at this point is to have an honest discussion with your surgeon about what you had hoped for and what he/she thinks. If your surgeon feels comfortable and has experience in revision rhinoplasty, that is one option. Often patients who are disappointed with a result do not feel confident the same surgeon will be able to deliver the results they want to achieve. Other times the surgeon actually only does primary rhinoplasty and not revisions, or has limited experience doing revisions. In any of these scenarios, it is best to at least get a second opinion from a board certified plastic or facial plastic surgeon that has experience with revision rhinoplasty. That is the only type of surgeon who will have the full set of tools required to adequately correct a nose. Sometimes you will get advice that matches your original surgeon and then at least you can go into the next surgery with more confidence.

Boris M. Ackerman, MD · Answer

The nose is a focal point on the face. It is important to envision what a Rhinoplasty result will look like on any give face. The patient and the surgeon need to communicate clearly what type of changes are planned. In my practice we use computer imaging in order to achieve this communication. Of course this will not guarantee the result, but it does help avoiding miscommunications. It appears that in your particular case you received more of a scoop that you want. Consult an experienced revision Rhinoplasty surgeon to see if you can have the required nasal correction.

Ronald Schuster, MD · Answer

The bridge of your nose has certainly been lowered significantly. Miscommunication and technical steps can both contribute. The important question is not really how it happened but rather if it is important enough for you to have it improved, and if so, is your previous surgeon the right one for the job. That answer can only come from your gut after spending more time discussing the issues with your surgeon. Good luck.

Michael A. Persky, MD · Answer

Hi NoseJob,

	The good news is that I do not believe that you are in future danger of having collapse of your nasal bones in the future.  The bad news is that there was a disconnect between what your aesthetic rhinoplasty goals were, and what your PS gave you at surgery.  The communication between patient and rhinoplasty surgeon pre-operatively is so very important.  Patients should be confident that their surgery understands what they want, and what they would be happy with post-operatively.   If your nasal appearance continues to bother you at a year or later after your surgery, then you may consider revision rhinoplasty to build up your nasal dorsum.  Good luck and be well.

	Dr. P

Michael A. Epstein, MD, FACS · Answer

Very often, when performing revision of one portion of a nose this may lead to the necessary alteration of other parts of the nose to keep proportions aesthetically pleasing. It is difficult to assess your nose from the photos given. If you truly do have an over resected dorsum, it is possible to augment the area with cartilage or even an implant.

Amy T. Bandy, DO, FACS · Answer

I agree with Dr. Johnson. The photo is a bit blurry, but it looks like you may have a supra-tip fullness. Over the course of the year after surgery, you will have a better idea if this will be something that you will want corrected. Good luck!

Toby Mayer, MD · Answer

I tell all of my patients that the wine from between the eyes to the check should be a straight line not a scoop though the check should be in front of the bridge. It's too much was removed from your bridge this can be revised with septal cartilage grafting and or soft tissue. See a very experienced revision rhinoplasty surgeon for the best results

John Michael Thomassen, MD · Answer

Dorsal hump reduction will generally not lead to nasal collapse or loss of projection in the future. Excessive septal cartilage excision is more of a concern for this occurring. Nasal tip work can be done separate from dorsal reduction in some cases. Good rapport and communication with your surgeon should get you where you want to be.

Michel Siegel, MD · Answer

From the photos you posted, Yes. There seems to be a classic saddle nose deformity from excess bridge removal. This will give a washed out appearance from the frontal view.

	Your tip seems to be over-turned as well. Both of these features create a more feminine appearance.

	Consult an experienced Revision Rhinoplasty Surgeon in your area.

	Best,

Mohsen Tavoussi, MD, DO · Answer

There is interrelation between the different areas of the nose with each other. The overprojected tip can make the dorsum look low and vice versa. You can either have the dorsum augmented or the tip deprojected.

Too Much Removed from Bridge? (photo)

Answers (16)