Deformities 11 months after primary rhino. What can I do about this? (Photo)

Question

11 PO primary rhino. Originally discussed deprojection, narrowing the lower lateral bones (Dr. said osteotomy or rasps) and reducing the tip. He never performed osteotomy or rasp to narrow the nose. Still a bit overprojected/heavy and now I have a bump. Looks like inverted V in video / certain lighting. Dr rec goretex to improve the V but it will make it wider. I feel like it’s because the dorsum/bridge/tip wasnt reduced enough. Thoughts? I feel like I didn’t get what I paid for + it’s worse.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you have instability and collapse of the dorsal aesthetic lines. Do not use a Goretex implant. That will cause numerous complications in your nose. Instead, you should have MTF Cartilage to rebuild the dorsal aesthetic lines with spreader grafts and a soft fascial onlay graft. You could also undergo tip deprojection and other maneuvers at the same time. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified plastic 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

Steven M. Denenberg, MD · Answer

If the doctor wanted to place a Gore-Tex implant to correct your inverted-v, that's a problem. Your instinct that it would make the nose bigger is probably correct. You fix an inverted v by narrowing the nasal bones that were inadequately narrowed in the previous operation.

The photos you submitted only give a tiny hint of what's going on, because, no offense, they are terrible for actually evaluating a nose from the standpoint of what to do, but the problems you complain of are pretty typical after an average rhinoplasty. Most likely you could get a better result with a revision in expert hands.

William Portuese, MD · Answer

A full set of facial photographs from all angles that are in focus, are going to be required to make a determination about how best to proceed. It's also important to obtain copies of the operative report to find out what was accomplished in the first procedure. If there's a dorsal hump present, that can be filed down. Osteotomy's are performed when there's a wide bridge line or an inverted V deformity. It's also important know how much cartilage is left over on the inside of the nose for grafting purposes, since that cartilage is used for grafting purposes to help with the inverted V deformity.

Deformities 11 months after primary rhino. What can I do about this? (Photo)

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