18 months ago I had removal of a skin graft and a full rhinoplasty. Do I Need a Revision? (photo)

18 months ago I had removal of a skin graft and a full rhinoplasty.The skin was extremely tight post op and the stitches caused an indentation between the bridge and tip of my nose where the skin graft/cancer was originally. My surgeon has suggested filling the indentation with Juvaderm but I will have to get it redone every 2 years. I am not happy with the high tip and exposed nostrils. Could a revision straighten the bridge permanently, lower the tip and even up the twisted nostrils?

Doctor Answers 7

Do I Need a Revision?

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 From the photos provided there is quite a bit going on aesthetically with the nose.  The bridge appears a bit scooped and the tip is quite asymmetric and over-rotated.  The nostrils are uneven and the anterior nasal septum is bent and visble within the right nostril.  Because of the skin graft a concern remains over the amount of skin and blood supply.  For these reasons an in person consultation is a "must" in my personal opinion before having a Revision Rhinoplasty.  

Revisional Rhinoplasty Needed

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Given that you are considering a revisional rhinoplasty for your tip and nostril issues, this would be a good time to build up the tissues under the bridge skin with cartilage grafts. Your bridge needs to be raised, the tip lowered, and your nostrils straightened, all of which will need cartilages grafts to accomplish those goals.

Do I Need a Revision?

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Yes you need "open rhinoplasty" with cartilage grafts to correct the issues. This is a very involved surgery that could last a few hours. and the fees are in the $10,000 range. 

Revision rhinoplasty can work.

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It is hard to be absolutely sure just from pictures, but I think you will benefit by having a revision.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Revision rhinoplasty

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I think you have a rather difficult situation.Without clinical examination I can only suggest if the skin grafted area has become soft and supple then perhaps bridge can be elevated and straightened by a very thin sliver of silicone implant custom fabricated on the operation table along with tip plasty to lower it which may also help to correct the twisted nostrils.I am sure you will receive many different opinions on your situation from various PS.This is just one of the suggestions.

Wishing you all the best

Rhinoplasty revision for the short nose with asymmetry.

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A rhinoplasty revision can be done to lengthen the nose if the skin has enough elasticity once it is separated from the tissue below. If the skin is too tight it can be stretched with a small balloon first. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Revision After Previous Rhinoplasty Following Skin Cancer Removal

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        I would explore the options of a filler or a cartilage graft for the indentation and nostril symmetrizing procedures

          The tightness of the skin envelope is the primary determinant of what can be done in this case.  The skin cancer had to removed for your health, and that was the most important thing.  The skin graft defect was closed, and you have a deficiency of skin at a critical point.  Tissue rearrangement is a possibility to improve the tightness of that area, but that involves the creation of additional scars.  That is why the surgeon did not do this initially.  Filler is reasonable to try at this point for the indentation.  A cartilage graft could even this out as well.  The high tip is the most diificult to fix, because you have skin tethering the tip.  Your nasolabial angle is not that much greater than 105 degrees (the upper limit of normal) and is not unattractive.   Finally, asymmetric nostrils can be improved through a variety of techniques but will never be perfect.   Good Luck.

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