I have extra cartilage on left side of the nose. It's caved on the right. Do I need a revision to make it straight? (Photo)

Question

I had rhinoplasty 10 years ago. And I absolutely loved my nose. But over the years, I notice a bump on my right side and caved on the right. Making my nose appear crooked, and have a beakish appearance. Do I need to seek revision rhinoplasty to fix this? I love my nose looking straight on, so I'm not looking for a drastic change.

Alejandro Nogueira, MD · Answer

Being true your problem is congenital, not very common and 
atypical... it is hard to understand you still have not been provided a 
clue; you suffer BILATERAL INVERTED / CONCAVE LATERAL CRURA OF THE ALAR CARTILAGES.
Normally the lateral cruras are convex, with the belly outwards, flat
 in the worst case or with slight concavity; but it is pathologic having
 them both or one inverted to the fullest, like a nutshell downwards, 
creating the typical pinched look and hollow effect you show in your 
images.
There are different techniques suggested by the few surgeons with 
wide experience in them; I have personally operated on dozen of such 
inversions of cruras. In your case (so assymetrical) it is likely you need full crura 
replacement by a hand made graft, however I'd try intraoperatively to 
evert it flippling and cross locating, however if this did not work in a
 nice shape then I'd carve and tailor a new crura out of concha bowl 
cartilage grafting.
The rest of your tip needs also tip plication, correction of the cleft, revision of previos work, also you seem to have supratip and upturned tip.
Beware, let me insist, if you are given any kind of diagnosis or 
proposal other than the one above, few surgeons understand this 
congenital condition; you might end in a mess of deformity otherwise.
If you wish better grounded opinion please do post or send privately 
well lit, focused and standard images: frontal, both lateral and both 
oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

William Portuese, MD · Answer

A revision rhinoplasty is more difficult than a primary rhinoplasty, so it important to choose your surgeon  very wisely based upon experience and producing  natural results.  The  nasal tip cartilages appear to have  shifted slightly from previous surgery and the shrink wrap  effectss of the skin.  Thin skin present in the tip of the nose tends to have  every little imperfection showing through.  Some minor adjustments can be performed to the nose to make it more symmetrical and refined.

Julie Edween, DO · Answer

BBle1234,Over time your nasal cartilage may have shifted, or may have been influenced by the contracting of skin and scar over time.  A revision rhinoplasty will be able to fix the contour irregularities around the underlying cartilage, and this may the reason that you are noticing the changes on tip of your nose.  Seek a nasal specialist in revision rhinoplasty.  A thorough nasal examination and consultation will outline the available options for you to achieve your desired results.  Best of luck!Dr. Edween

Michael F. Bohley, MD · Answer

Thank you for your question, and excellent photos. The paired Alar cartilages define the tip of the nose, and provide its shape. The rest of your nose looks very good. Even after a successful rhinoplasty, scar tissue formation and the passage of time, can shift the position of these small cartilage elements. A Tip Rhinoplasty approach can be used to reposition the alar cartilages without changing the good shape of your upper nose.

Myriam Loyo, MD · Answer

Hi there, thank you for sharing your photos and question. It appears that over time the cartilages in the tip of your nose have shifted in position. This tends to happen due to the inherent strength of the cartilages and due to progressive contraction of the skin. A revision surgery would be the best option to strengthen and improve the match in shape of the nasal tip and of the nasal cartilages. Hope this helps. Good luck!

I have extra cartilage on left side of the nose. It's caved on the right. Do I need a revision to make it straight? (Photo)

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