Rhinoplasty November 2023 - Slight bulge on the left side of my nose. What is the issue here? (Photos)

Question

Hello, I got a rhinoplasty in November of 2023. It has healed nicely, but there is a slight bulge on the left side of my nose. When I push it, I can breathe better out of the right nostril. It feels like the cartilage moves, but once the pressure is gone it goes back. I can breathe out of both nostrils semi decently, but I notice I tend to half smile to flare my right nostril to get a full breath constantly. It’s left uneven smile lines since I do it so much. I am thinking about revision options, or other alternatives to help the breathing on this side. It is extremely bothersome. What do you think happened here, and how would I describe this to a plastic surgeon? Thanks in advance!

Steven M. Denenberg, MD · Answer

Specifically fixing something where pushing on the side of the nose improves the breathing is likely impossible. Doctors may "try" things that take the risk of making your nose look much worse, like "spreader grafts," which sound great in their rationale, but rarely work. If the septum is still bad, perhaps that septum can be a partial cause.
I would love for you to see morphs of what your nose would look like if the tip were elevated and brought back closer to your face. To me, the photos show a nose whose tip is strong in its forward projection away from the face relative to the position of the bridge. That feature also makes the 3/4 views look long-ish. Also, in most noses, simply elevating the tip tends to improve the airway, though of course it's no guarantee that it will fix what you are noticing.
These are not changes that most rhinoplasty surgeons would be able to make with expertise and predictability, especially in a revision, so if you decide to explore that option, you'd have to be very careful in selecting your surgeon.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can understand from your question The slight bulge you describe may be due to mild cartilage displacement, residual swelling, or internal valve collapse affecting airflow. Since pressing on the area improves breathing, it suggests a structural issue with nasal support on that side. This can often be corrected with a minor revision or cartilage graft to stabilize the internal valve and smooth the contour. I recommend waiting at least 12 months post-surgery before any revision, and discussing both functional and aesthetic correction with an experienced rhinoplasty specialist.
It would be better face to face consultation.
Best Regards!

Eric M. Joseph, MD · Answer

It is not clear to me why you would breathe better through the right side of your nose while compressing a cartilaginous bulge on the opposite side. I think the most reasonable thing to do would be to make a follow-up appointment with your surgeon and ask him why you're not breathing properly. Diagnosing your way obstruction is fairly straightforward with a Q-tip, a nasal speculum, and a headlight. Wishing you well moving forward. Sincerely, Dr Joseph

Alejandro Nogueira, MD · Answer

Your bridge has been over scooped, it is totally vertical and parallel to the maxilla, it is a saddle nose and over projected and voluminous tip; additionally you have high osteotomy hence visible lines of them, open roof and a collapse of the middle vault because of the aggressive resection of the dorsum; this latter is the cause of your breathing issues.

You need a complex revision if you wished to correct your result, aesthetically and functionally.

You need a complex revision if you wished to correct your result, aesthetically and functionally.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include breathing improvement, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. That area of your dorsal aesthetic line can also be improved. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Rhinoplasty November 2023 - Slight bulge on the left side of my nose. What is the issue here? (Photos)

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