I had my plastic surgery about a year ago (06.20.2011). My nose was originally very problematic (crooked , uneven nostrils, hypertrophic left side of the nose). Although in general i am satisfied with the doctor's job in profile and in particular on the functionality of the nose, I feel that my nose could be more improved. My nose is still very big. And the two sides of the nose are still uneven. Can a second surgury fix these problems?
Candidate for Revision Rhinoplasty? (photo)
Doctor Answers 7
Revision Rhinoplasty would be Appropriate to Address Your Concerns
Hi Tom, thanks for the question. Based on what I can see from your photos, you have two predominant issues present on front view. The first is what we call the "parentheses deformity", in which your tip cartilages (lower lateral cartilages) are malpositioned towards your forehead rather than laterally, towards your cheeks. This creates a round look to the tip and the area above your tip, somewhat like two parentheses. Just above this, you have an "inverted-V deformity" related to your upper lateral cartilages falling in towards your septum. This can affect your breathing as well, as it narrows the internal valves of the nose.
Correction of the parentheses deformity involves lateral crural reposotioning, which means freeing up and moving the ends of your tip cartilages down and to the side, closer to your nostrils. In some cases, cartilage grafts are placed underneath the tip cartilages to straighten and strengthen them. The inverted-V deformity is corrected with spreader grafts, which are long thin pieces of cartilage (ideally from your septum) which are stitched in place along each side of your bridge, to lift your upper lateral cartilages back out.
These are both common problems I correct in my revision rhinoplasty practice. You should certainly address your concerns with your primary surgeon but it may be worthwhile to get an opinion or two from other revision rhinoplasty experts. Also, if you have breathing difficulty, insurance coverage may be a consideration.
Candidate for revision rhinoplasty
The hard question to answer is whether a small revision is really worth the risks related to undergoing general anesthesia for minor changes to the nose. There will always be some uneven nostrils present, even after the most perfect nose surgery. Very minimal improvement on the nose can be fraught with complications throughout the healing process so it is sometimes best to just say enough is enough.
Parenthesis tip following primary rhinoplasty.
I agree with Dr. Mehta in that you have a classic parenthesis tip deformity. I also agree with his recommendation to correct this problem. However, I am not so sure from the photographs as to the presence of an inverted V-deformity. A manual examination would be necessary to confirm this. If an inverted-V deformity is present, then it is visually mild and clinically not significant because you report substantial improvement in nasal function.
Mario J. Imola, MD, DDS, FRCSC
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Candidate for Revision Rhinoplasty?
Your nose appears to be asymmetrical, with an overprojected tip, and wide base that could be significantly improved with revision surgery. Make sure you find a surgeon who does a lot of revisions because this work is a true specialty.
Candidate for Revision Rhinoplasty?
As the answers from others have indicated, your results may be satisfactory but may be able to be revised. In person consultation is required to determine if the benefits outweigh the risks. Explore your options with the original surgeon. If you do not get a satisfactory response from the original surgeon, consult with 3 - 4 board certified plastic surgeons in your area to understand your options and the associated benefits/risks.
You probablynhave a very satisfactory result (your before pictures were not shown). Revision surgery is not without risk and could give you a worst result.
In my opinion you would benefit from a revision rhinoplasty. You have some functional issues as well as cosmetic. There are some issues with the placement of the grafts. You can also improve the appearance with some narrowing as well as tip support. I would schedule an appointment with your surgeon and let him know what your concerns are. I believe that you are probably still experiencing some functional problems.