Would a revision help fix this? What would you do to fix it? (Photo)

Question

Had septorhinoplasty over a year ago but I still feel like the tip of my nose is too round and my nostrils are showing way more than they did before: There is an obvious asymmetry with my nostrils too and I wonder if there is a way I can fix this along with the round tip. My nose also looks very big and looks like I’m flaring my nostrils if I’m smiling. Would a revision help fix this? What would you do to fix it?

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. Since your initial surgery was over a year ago, you may consider revision rhinoplasty to address your aesthetic concerns. Treating wide nose nostrils requires an alar base reduction, which involves removing tissue to create a more narrow and symmetrical appearance. A tip plasty can also be performed to correct the size, shape, and definition of your nasal tip. Suture placement can narrow the tip, while cephalic trimming removes cartilage to reduce its width and rounded shape.

It’s important to note that each subsequent nose surgery becomes more complex due to the loss of structural support, scar tissue, and other factors. The importance of experience, expertise, and artistry cannot be overstated. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon, with expertise in rhinoplasty techniques, such as alarplasty and tip plasty. They will be able to review your surgical history and your concerns to determine the best treatment plan.

Jeffrey H. Spiegel, MD · Answer

Yes, I think a revision rhinoplasty is in order.  The tip of your nose is still bulbous and you have alar retraction / notching of the nostrils.  Cartilage would be added to fix these areas. I'd want to do extended spreader grafts to fix the sides, batten grafts to fix the bulbousness and side collapse, rim grafts for the alar notching, and more. It would take about 90 minutes.
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Selcuk Inanli, MD · Answer

Hello! Thank you for your question.From the photos you provided it looks like your columella is too low (hanging) and your nostrils are flaring. Your nostrils are uneven and they're too big compared to your face.I recommend you a revision rhinoplasty surgery. We will most probably need to use cartilage (from ear or rib) for a reconstruction. 
Best regards!Prof. Dr. Selcuk Inanli

Philip S. Schoenfeld, MD, FACS · Answer

You have an issue that can be fixed with revision rhinoplasty.  In reducing the size of your nasal tip in your original surgery and likely providing you with upward tip rotation the lateral crura of your lower lateral cartilages were over resected.  Placement of articulated alar rim grafts and elevating the medial crura are two maneuvers that can help address excess columella show and alar notching.  I realize that this is probably Latin to you but a good revision rhinoplasty surgeon will know exactly what we are talking about.

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