Dent in nose after rhinoplasty? (Photo)

Question

I had rhinoplasty in February of 2014. I was doing it for cosmetic reasons but then was told I actually had a deviated septum as well. Looking at the before and after photos- it seems like my nose wasn't symmetrical before but the surgery seems to have made that stand out more. Is there anything I can do? Would fillers help?

Gregory S. Keller, MD, FACS · Answer

Different fillers are an option to fill in the concave area on the left side of your nose.  While this will largely correct the asymmetry of the nose side-wall, it will need to be repeated on a regular basis.  Since you are young, this may represent a lifetime of cosmetic "upkeep and maintenance" that is expensive, time consuming, and somewhat painful.  Fillers might be a stop-gap" band aid, but, for the long term, you should consider revision septoplasty and rhinoplasty.

Function of the nose and cosmetics, go hand-in-hand.  With the narrowing of your nose and a deviated septum, your airway can be reduced, especially as you age and the cartilage and bony structures of your nose weaken. Using cartilage from the correction of your septum, an experienced surgeon can correct your concave sidewall and your nasal tip so that your nose and airway have structure that lasts for life, as well as an open airway.

I would talk to your doctor about this.  If he/she does not wish to perform a septoplasty and revision rhinoplasty, there are many San Diego Otolaryngologist/Fellowship Trained/Academic Facial Plastic Surgeons that specialize in this type of work and perform more of these operations than other general plastic surgeons.

Emmanuel Mallol Cotes, MD · Answer

Thank you very much for sharing your concerns about your Rhinoplasty with us.

After having analyzed all the info and photos provided to us, i recommend to perform a Secondary Rhinoplasty (not a tip revision) this means (basically) treat the nasal bones and the nasal cartilages.Therefore i would perform a narrowing of the nasal base (nose osteotomy) and alar and triangular cartilage shaping.

Respectfully,Dr. Emmanuel Mallol Cotes.-

Juan Carlos Fuentes, MD · Answer

Your nose has some asymmetries and a hyaluronic acid based filler can help with the dent on the collapsed left side of the nose, but in the tip of the nose you also have an alar retraction, that the filler will not correct and it not advisable to use a filler there. It will be better to get a secondary rhinoplasty to correct that problem.

Vincent P. Marin, MD, FACS · Answer

You do have a small indent on the left side of the nose. This is not as prominent unless the nose is isolated in the photos. That, however, can be easily corrected with a filler in the nose. The only concern is that it is a temporary correction. Formal revision surgery is a permanent correction, but a big hurdle to overcome.

See your doctor or a board-certified plastic surgeon in your area to get a formal opinion.

See your doctor or a board-certified plastic surgeon in your area to get a formal opinion.

Victor Chung, MD · Answer

Revision rhinoplasty is a surgery to improve the shape of the nose for breathing or appearance after a previous nose shaping surgery.In the photos provided, the nasal bone and cartilage are depressed on the left side. The nasal bone needs to be moved and then supported with a spreader graft. Using filler as a touch-up after rhinoplasty is getting increasingly popular, even advertised as a "quick-fix." Although it can potentially help in the right situations, fillers in the nose have higher risks than filler in the rest of the face. It is a temporary measure that needs to be reinjected every 1-2 years. Most importantly, it does not replace good rhinoplasty technique. I recommend a consultation with your original surgeon and a revision rhinoplasty surgeon to discuss appropriate options for a safe and happy result. Safety comes first.

Edward Farrior, MD · Answer

There is persistent deflection in mild collapse of the middle portion of the nose on the left in addition to some asymmetries of the tip of the nose and nostrils.  Filler is not recommended in the tip of the nose but can be used in the sidewall to camouflage the depression.  It will not resolve the problem or be a permanent fix.  Fillers must be repeated every 12-24 months.  Because of the dense vascularity of the nose I would use fillers cautiously and discourage my patients from using that option.   I recommend that you discuss your options with your initial surgeon and follow their advice.  If you are seeking a second opinion then choose a physician with a lot of experience in secondary, revision, rhinoplasty. From looking at your photographs I believe that the asymmetries that exists will become more pronounced over time.

Fred J. Bressler, MD, FACS · Answer

Thanks for your post. You appear to have a small concavity of the left upper lateral cartilage and/or left nasal bone. This minor anatomical variant was present pre-op and may be more visible to you now. Fillers are temporary and are associated with some risk to the skin. One option would be for you to consider revision with a cartilage spreader graft and/or reposition of the left nasal bone. Consult with your surgeon regarding recommendations if you are truly concerned. There maybe other options worth your consideration. Best wishes.

Arian Mowlavi, MD, FACS (license on probation) · Answer

You will do great with a filler called Radiesse which will be able to fill your left nasal dorsum side wall beautifully.

Dent in nose after rhinoplasty? (Photo)

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