5 years post rhinoplasty - poor aesthetic result. Would a revision improve my results? (Photos)

Question

I had a primary rhinoplasty 5 years ago where the results were initially not bad but with time, more irregularities became apparent. I don’t have major breathing issues and post operative swelling masked some of the aesthetic issues for a while but the nose looks different now. It may be useful to mention I had ear cartilage grafted to fix a small asymmetry on the left side, which may have warped or been misplaced or something causing that left lump but could be scar tissue or something else, idk. My nose has a large bump/lump on the left side of the bridge subratip area (my left your right) as well as a tiny depression on the same side near the middle of the bridge, there is also some sort of bump on the middle of the subratip, slightly towards the left again that from the side profile and 3/4 profile gives it a polybeak deformity type of look. Also, the tip, infratip and columella all have cartilage sticking out awkwardly, particularly on the left side but also slightly on the right which (apart from the tip, I am fairly happy with the right side profile just not the left). Also, the tip appears to project too much but this could be due to the depression of the bridge or other aspects of the nose such as the tip issues. I would like a natural nose with smooth tip cartilage that doesn’t project and a nose bridge with smooth contours and a smooth straight left side contour similar to the right. Would a revision be worth it and what can realistically be done?

Randal Haworth, MD, FACS · Answer

Five years out, what you see is essentially the settled result, which makes this a fair time to think about revision. I cannot judge the first operation from photos, but the features you list are recognizable patterns. The left-sided lump and the small depression near it may come from an ear cartilage graft that has shifted or warped, irregular bone or cartilage edges, or scar tissue, and only an examination, sometimes with imaging, separates those. Fullness above the tip that creates a polybeak look generally comes from cartilage left high in the supratip, scar tissue filling that space, or a tip that has lost support relative to the bridge; each is treated differently. Cartilage edges showing at the tip, infratip and columella usually mean grafts or tip cartilages have become visible as the swelling resolved. A revision would generally aim to:1. Remove or reshape the irregular graft and smooth the bridge, using camouflage grafting where there is a depression.2. Restructure the tip, often with septal or other cartilage, so it is smooth, supported, and projected in proportion to the bridge.3. Deal with supratip scar tissue and the tip-to-bridge relationship that produces the polybeak appearance.Revision rhinoplasty is more demanding than a primary operation; scar tissue, skin thickness and the cartilage still available all set limits, so what is realistic has to be defined in person. A consultation with a board-certified surgeon who performs a large volume of revision rhinoplasty, with full photographs and an internal exam, is the sensible next step.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. 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. FACS
Harvard-trained board certified plastic surgeon

Best wishes and good luck.

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

Thomas Trevisani, MD · Answer

In person exam is essential as well as review of standard photos . Based on limited photos submitted- it appears that you would benefit from a revision Rhinoplasty preferably performed through a closed technique with possible cartilage grafting . I suggest that you seek an experienced Board Certified PS with extensive Rhinoplasty experience

5 years post rhinoplasty - poor aesthetic result. Would a revision improve my results? (Photos)

Answers (3)

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