I had my first rhinoplasty 1 year ago (total rhinoplasty), and while I am happy with it for the most part, it appears that my right nasal bone is not as narrow as my left one. How hard would it be to correct this with a revision rhinoplasty? Would both nasal bones have to be broken or would only the right one require cutting and repositioning? Lastly, by having a secondary surgery, could the right nasal bone become even further asymmetric or is the risk for that happening low? Thank you so much
How Risky is Narrowing Nasal Bones in Revision Rhinoplasty?
Doctor Answers 9
Narrowing nasal bones in revision rhinoplasty
Revision rhinoplasty is always more difficult than the primary rhinoplasty. Revision rhinoplasty can include revising the tip cartilages, upper lateral cartilages, or nasal bones depending upon the patient’s wishes, needs, and desires. Asymmetrical nasal bones usually require some degree of osteotomy of either one or both nasal bones depending upon the presenting issues at hand. Look for a very experienced rhinoplasty surgeon who has performed thousands of rhinoplasties prior to embarking on this type of procedure.
You can perform osteotomies to just one side of the nose
Yes, you can perform osteotomies to narrow just one side of the nose. Typically, an osteotomy would need to be done laterally (where your nasal sidewall and cheek meet) and medially (where your right nasal bone meets the left on your bridge). You wouldn't have to affect the left side at all.
The best option to address your concern would be formulated with an in person exam. This would allow for a better assessment of the rest of your nose.
Nasal bone revision
There is always asymmetry of the nose and at least from the photos, I do not see a significant difference to warrant revision surgery.
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Revision rhinoplasty requires accurate diagnosis.
Going by your picture, you probably do not need nasal bone narrowing.
What you have on the right side is called "middle vault collapse". This is a cartilage displacement problem, and is best corrected with a cartilage graft. Surgery is tricky, but results can be very good.
Revision rhinoplasty for asymmetric nasal bones.
Almost all faces are asymmetric. i.e. one side is longer than the other that includes the nasal bones. This may be very obvious is some patients or minor in others. However, occasionally, small surgical maneuvers may camoflage this asymmetry. These include, different way of cutting or shaving bones. Sometimes, placement of crushed cartilage on the depressed side to even things out. Cutting nasal bones(osteotomy ) and readjusting will cause narrowing of nasal cavity but it should not cause perceivable nasal obstruction. Redoing the surgery to adjust one side or the other should be the same. Finally, there is always chance of complications with any surgery which you should be aware. Best
Bony asymmetry after rhinoplasty
You should get improvement of this through right-sided only medial and lateral osteotomies. This is a quick (5 minute) procedure under IV sedation.
Asymmetry of Nasal Bones after Rhinoplasty
Nasal bones can be repositioned after a primary rhinoplasty. The osteotomies may be done on one or both bones - sometimes it is also necessary to do an osteotomy in the center of the bone(an intermediate osteotomy). The best approach will be determined by your surgeon or revision specialist during consultation.
Revision rhinoplasty for asymmetric bones.
You may want to consider a Non-Surgical Rhinoplasty procedure instead of Revision Rhinoplasty Surgery. Video attached.
I read your concern and reviewed your photos. You appear to have a slight indentation in your mid-nose on your left. You could have restoration of nasal symmetry with a well-performed Injectable Filler procedure: this could add a slight amount of volume to your left mid-bridge and help improve your appearance. In my view, this is a better option than undergoing another nose job surgery. My personal preference is to use Silikon-1000, an off-label filler, for permanent results.
I hope this is helpful for you.
Regards from NJ: