Shell I Risk 4th Rhinoplasty/revision? (photo)

Question

I had two rhinoplasties few years ago and was perfectly happy after second one. Since had breathing problem, decided to have medical surgery a year ago, which left my nose disfigured, it`s too short, too high, crooked and badly stitched. I haven`t recovered since. My first surgeon, who gave me my fantastic nose before, says it would be too risky to have another surgery and he doesn`t recommend it. We do fillers now, but I`m not very happy and want a lifetime solution. Shell I risk 4th surgery?

Paul S. Nassif, MD · Answer

Hello, and very sorry to hear about the negative result you have experienced from your most recent surgery. In general, I would not recommend having filler injected in the nose. I have seen too many complications arise. These complications may include infection, rejection by the body, asymmetry, and necrosis (the tissue dies). In the hands of a revision rhinoplasty specialist, a revision can help and improve the appearance of your nose. I would recommend seeking the opinion of a board certified revision rhinoplasty surgeon who uses computer imaging software. They can morph a photo of you and give you an idea of how the final result of surgery may appear. When looking for a surgeon, consider their experience, before and after photos, and patient testimonials. I hope this helps, and I wish you the best of luck.

Alejandro Nogueira, MD · Answer

ASAP, give up fillers, you are damaging the tissues and making more difficult, riskier and eventually at a certain point unfeasible your revision rhinoplasty.Based on the images I have to doubt you major deformity is due to a simple medical surgery on you like, I guess, a septoplasty; since there are sever damages like a saddle nose deformity in extreme grade, a total collapse and pinching of the nose, a iatrogenic short nose, open roof deformity, inverted V deformity, upturned nose to to massive over resection of structures, and a long etc.Your case is of very high difficulty, but can be fixed, actually I have done worse cases and in wost multioperated tissues; my first advice is stopping the fillers or other injections right away, they show poor medical manage and null understanding of the risks associated to them, which are aggravated in poorly vascularized tissues like in your nose.You'll need, due to the massive shortfall of structures, probably rib grafting, so seek the help of a surgeon comfortable with this option, its delilcate harvesting and its artistic sculpting.For a more in detail assessment you could post better images, unblurred and from all angles.Seek the advice and hands of a serious professional who offers to you a time-consuming and expensive procedure; stay far from minimally invassive snake-charming procedures, synthetic implants, fillers, wrapped diced cartilage, etc.
Difficulty 9 out of 10 in revision rhinoplasties, surgical time about 6 hours (in expert hands, could be even longer).
See the link below to find few cases of my own practice very similar to yours which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted.
If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views, also from underneath.
Feel free to request any additional information from me.

John M. Hilinski, MD · Answer

Looking at the photos, I think you would benefit more from doing a formal revision rhinoplasty surgery. Obviously any final determination would require an in-person consultation. But I would certainly not recommend fillers to address the main issues that I can see. That being said, you need to consult with an expert in revision rhinoplasty surgery who has dedicated experience in managing this type of complex, challenging revision case.

Kenneth Hughes, MD · Answer

Physical exam and nasal support determination as well as breathing status is always critical prior to a revision operation.  An operation can be performed in which extended spreader grafts can be used to improve the dorsal aesthetic line and lengthen the nose as you want.  The nostril asymmetry can be improved with a lateral crural strut graft.  Once again, these are just a couple of suggestions.  Always seek out a rhinoplasty surgeon who has perfomed at least a few hundred of these operations.

Edward Farrior, MD · Answer

You could achieve improvement with a fourth rhinoplasty, third revision.  There is obviously loss of support that will not be corrected temporarily or permanently with injectable fillers which only camouflage the problem.  Because of the number of previous surgeries there is probably very little cartilage remaining in the septum that could be used to reconstruct your nose.  This would more than likely necessitate the use of rib cartilage to strengthen the nasal dorsum and create a more natural and less turned up or infantile appearance to the nose.  With the degree of apparent over resection, I would expect your nose to continue to deteriorate over time and encourage you to seek consultation regarding revision surgery relatively soon so that more permanent contracture of the skin envelope does not occur, which would compromise any revision surgery.

Shell I Risk 4th Rhinoplasty/revision? (photo)

Answers (6)

Answer: Extended Spreader Grafts for a 4th Rhinoplasty

Answer: Extended Spreader Grafts for a 4th Rhinoplasty

Answer: Multiple revision rhinoplasties, augmentation and lengthening

Answer: Multiple revision rhinoplasties, augmentation and lengthening

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Everything you need to know about Revision Rhinoplasty

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Shell I Risk 4th Rhinoplasty/revision? (photo)

Answers (6)

Answer: Extended Spreader Grafts for a 4th Rhinoplasty

Answer: Extended Spreader Grafts for a 4th Rhinoplasty

Answer: Multiple revision rhinoplasties, augmentation and lengthening

Answer: Multiple revision rhinoplasties, augmentation and lengthening

Browse related questions

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.