What are my options? Nostril collapse after having my deviated septum repaired and rhinoplasty. It been only 1 year (Photo)

A revision rhinoplasty will be necessary to support both the alar rim and or valve. This is a procedure that should be done by a revision rhinoplasty specialist who has a great deal of experience. Look at the before and after photos 

Thank you for your question and photos.  Normally, 7mm of intact lower lateral cartilage is sufficient for support if the cartilage is strong and straight.  It appears that yours may be overly curved (from the indents you can see on the lateral view along the alar groove).  Collapse of the lateral wall is multi-factorial including weak lateral wall, or narrow aperture.  Your right nostril is a little more narrow than the left.  This will lead to more negative force on the lateral wall on this side when you breath in.  You should discuss your concerns with your surgeon.  If you are not comfortable with him, seek a second opinion.  You have a residual dorsal hump that could be revised in the same surgery. You will likely need cartilage grafting to strengthen the area that is collapsing.  All the best!

This issue can be fixed with additional cartilage grafting to your nose and nostril It is likely that you will need to have a rib graft harvested and a strong structural support added to the collapsing area. This can help to prevent the obstruction on inspiration. Please consult with a surgeon who has experience in rib grafts and revision rhinoplasty as yours is likely to be a complicated procedure considering your vestibular stenosis.Best of luck,Dr. Marin

The cartilage supporting your right nostril is likely insufficient.  Internal airway exam is necessary to determine if any obstruction exists.  You will likely need more cartilage support during a revision.  This can be harvested from the ears.  Cadaver cartilage is irradiated and has a history of resorption.  Its use is more popular in Europe than in the United States.Express your concerns to your surgeon.  Even in the best of hands, rhinoplasty revision rates are 5-10%.  Continue with your surgeon if you have confidence in his/her ability to fix the problem.  Otherwise, seek a 2nd opinion with a few true rhinoplasty experts.

A frontal view would be helpful but from your base views it appears your tip is slightly off to the right side. The excision of cartilage in combination with other maneuvers is likely the cause of the collapse of your right nostril. I prefer to fix this issue by reopening the nose and placing several thin cartilage grafts to recreate some of the structure that is missing. A complete physical exam would also be helpful as if your septum is more deviated to your right side, a revision septo can help equalize the airflow through the nostrils so that the right side is not collapsing. Hope this helps.

Leaving behind 7 mm of lower lateral cartilage after the cephalic trim should be more than enough, even after an open rhinoplasty.  So I think there is more to your problem than that.  Several surgical maneuvers were performed, and even though your photos and description are very helpful, you would need a thorough exam to plan the next course of action.  You will certainly need some cartilage grafting, and whether that comes from your ear, ribs, or a cadaver graft has a lot to do with how much you need and surgeon preference.  Your septum is probably not an option for cartilage now, and whether it is contributing to your airflow/collapse problem would require an exam.

The cephalic trim is likely contributing to the nostril collapse but there are usually other forces involved. I agree that you will need to have cartilage placed back to hold the nostrils open. However, this cartilage can be obtained from your ear rather than using cadaver cartilage and would be a better option to use your own cartilage. The profile view also reveals residual bump on the bridge which could be due to over-resection of the cartilage or under treatment of the bony hump. The septum can move even after treatment due to the cartilage having "memory". However, there are maneuvers that can be done to bring it back to the middle. A thorough in person examination would allow a better assessment of treatment options.

Thank you for the photos and question and it is obvious you would benefit from revisional surgery to support your collapsing ala so see some experts in your area and see what they recommend after a full examinationDr Corbin

You are experiencing collapse of your right alar rim. There are several causes for this and yours looks severe from the photos and may have been caused by a cut/released lateral crural cartilage which extends down the alar rim region and keeps your alar rim out. The repair for this is simple and requires one or two cartilage grafts taken from your ear and placed both in the alar rim (contour graft) and possibly in your supratip region (alar batten graft). A consultation would be very helpful.

You will need a revision to re-establish support for your nostrils. The amount of cephalic trim and the lack of inherent strength of your cartilages may have contributed to this problem. You should schedule a consultation with an experienced revision rhinoplasty specialist who will diagnose the cause and discuss alternative procedures.