I initially had a closed rhinoplasty in 2010 to remove a large hump on my dorsum. I haven't been fully happy with the result and I feel the tip of my nose wasn't addressed. Any opinions re open/closed etc. would be appreciated. Also I would like to know what elements are wrong with my nose as if I'm going down this road again I want it to be the only time! I have a long nose, inverted v deformity, possible hanging columella and or retracted nostrils, can these be fixed? Photos included.
Considering a Revision Rhinoplasty for Hanging Columella/retracted Nostrils? (photo)
Doctor Answers 5
Well performed revision rhinoplasty may lead to an improvement in the appearance of your nose.
I read your concerns and reviewed your profile photos: You appear to have an overprojected tip, nostril retraction, a hanging columella, and a polybeak deformity. Well performed revision surgery may lead to an improved appearance. The expertise of your surgeon will be of paramount importance. A copy of your operative report would be helpful for you and your surgeon.
Considering a Revision Rhinoplasty for Hanging Columella/retracted Nostrils?
Frontal views would be necessary to comment on many of the questions asked. The caudal septum can be reduced a bit to improve the appearance of the columella and decrease apparent length of the nose. The tip can be refined as well. Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA
Alar retraction vs columella show
A single close-up photo does not give enough information, but solely based upon the photo and angle, it looks like you have more of alar retraction than anything else.
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Revision rhinoplasty for hanging columella, inverted V, and alar retraction
A revision rhinoplasty will be required to address all the issues above. All of these issues can be addressed through closed rhinoplasty. The hanging columella is addressed by a removal of both cartilage and skin in the columella called a columellar-plasty. This may or may not be enough to bring your alar-columella relationship back into alignment. If the alar retraction still present, then composite skin grafts from the ears will need to be added to the inside of the nostrils. Inverted V. deformity is treated with spreader grafts to the upper lateral cartilages and sometimes osteotomies if the bones are too wide. The lower cartilaginous dorsum and also be brought down to reduce the mild poly-beak present and any minor additional tip adjustments can be made at the same time.The link below shows examples of how we have addressed all the above issues through closed rhinoplasty
Hanging Collumella and Nostril retraction
Yes you are right it does look like you have those things. In addition, your tip is overprojected and you have a slight pollybeak. You will need to reduce the dorsal and caudal septum as well as cartilage grafts to help with the alar retraction.