Septum appeared to be showing through my skin, do I need a revision rhinoplasty?

Question

Over 2 years ago I had a rhinoplasty to fix a deviated nose. Unfortunately after the swelling went down my septum appeared to be showing through my skin. My surgeon told me that I have thin skin and I don't have a problem. I've gotten 2 injections of hyaluronic acid with the same surgeon. He told me that after a few injection it would build scar tissue. I don't see much of a difference and it still shows through my skin slightly. What do I do?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you appear to have an inverted V deformity of the dorsum. This area can be shaved down and spreader grafts can be placed to prevent it from happening again. Additionally, for very thin skin patients fascial onlay grafts can also be very helpful. 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

Eric M. Joseph, MD · Answer

We have had good success with microdroplet Silikon 1000 for camouflaging a dorsal septal line in thin skin patients after rhinoplasty surgery. If the overall contour of your nose is acceptable, this may be a viable alternative to revision rhinoplasty surgery. Since you have thin nasal skin, you will experience shrink wrap in the future too. I hope this helps. Sincerely, Dr. Joseph

Manish H. Shah, MD, FACS · Answer

Hello,
HA filler is a temporary solution and really won’t fix your problem. If you still have a hump then this area of septum needs to be trimmed down. If you do not then you now have an inverted V deformity. 
If it’s an inverted V you can either have revision rhinoplasty to correct it  by repairing the position of the upper lateral cartilages and cover the area with fascia to add a barrier layer, or you can have a simpler procedure of micro fat transfer to the bridge of your nose to camouflage the area. It’s best to discuss this with a revision rhinoplasty specialist if your surgeon doesn’t think they can improve on your results.
I hope this helps.
Dr. Shah

William Portuese, MD · Answer

Yes, indeed, you do have thin skin on the dorum, along with your nasal septum showing through, which is higher than your nasal bones. A revision rhinoplasty can accomplish shaving down the dorsal septum, which is composed of both bone and cartilage in that area. Osteotomies would be required to close any open roof, deformity, and harvesting temporalis fascia and inserting it over that area would camouflage that area as well to help with thin skin present.

Paul Chatrath, MBBS, FRCS · Answer

Hi, Thank you for your excellent question. From the photo it looks like it is your nasal bones which are showing through rather than the septum itself. It could well be the case that if you have thin skin, this will increase the visibility of the underlying nasal bones. It is something that can happen after rhinoplasty surgery and whilst it must be very frustrating, there is usually something that can be done. I would agree that fillers alone are unlikely to give rise to a long lasting and acceptable result, and given your recent experience with this, you may need a small revision to smoothen down the prominent nasal bones. This could possibly be attempted without breaking the nasal bones on the side however this will depend on how wide your nasal bones are (which does not come across in enough detail on the photos). I would suggest getting a face to face review with a surgeon experienced in revision rhinoplasty.

Septum appeared to be showing through my skin, do I need a revision rhinoplasty?

Answers (5)

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