Is there any solution for these indents and other weird shapes in the bridge of my nose post revision rhinoplasty? (photos)

Question

At 17 I got my first rhinoplasty, a great improvement considering the huge roman nose I had, but it was obvious it had surgery. At 36 I decided to get it improved. The tip is now fine, but the bridge is not. I had an open procedure and a second closed one with an ear graft, because the first time my nose collapsed looking like a birds beak. He also shaved the bone between my eyes, which turned into a bump of fibrosis, next to an indentation. To fix it, I got a fat tissue graft, which shifted.

Edward J. Gross, MD · Answer

If this was a primary nose surgery, I would consider revision rhinoplasty in 1 year with use of mastoid or temporal fascia. ENDURAgen from Stryker is a dermal collagen matrix that is also helpful for bridge deformities. However, if this was s second surgery, I would opt for injection therapy rather than more surgery. Radiesse has a calcium matrix that lasts many months or years in this application and has no risks.

Alejandro Nogueira, MD · Answer

It seems to me there has been no clear surgical plan or criterion when your nose was primarily operated, later on revisioned and finally injected with fillers.To begin with, grafting placed via closed approach is not a recommendable option in general, you can't control its placement, location, the size and shape, etc, and much less you can fix it; closed insertion of ear or other grafts is normally condemned to a poor if not very bad result.Your nose is a short nose syndrome at present time, you'll need a complex procedure to remove all the unsuitable materials, damaged parts and fibrosis; then a well thought and profesionally solid re-structuring plan has to be applied, using a series of grafts which is unclear due to the limited perspective of these images and somehow is never fully decided until the intraop assessment of the damages.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 8 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.

Sirius K. Yoo, MD · Answer

Thank you for your question.  Skin irregularities are common after revision rhinoplasty procedures and can be caused by bumpiness of the underlying bone and cartilage (especially in patients with thin skin) or scar tethering in the soft tissue envelope.  Both are commonly mitigated by placing a thin tissue graft between the soft tissue envolope and the bone/cartilage.  I generally perfer to use temporalis fascia for this, but there are several alternatives available.  If this is something that bothers you considerably, see a revision rhinoplasty specialist who can discuss this with you in more detail.  All the best!

Zoran Potparic, MD · Answer

Irregularities of nasal dorsum after revision rhinoplasties are not rare. This is usually because of uneven dorsum rasping, formation of scar tissue, bone dust left in the area, etc.. Dorsum revision through an external approach (like one you had first time) would give a better chance to evaluate and treat deformity. Placement of a your own fascia graft (taken from your temple), allograft or thin sheath of artificial material (Medpore) over dorsum may be considered. Please discuss your options with your surgeon and seek a second opinion as well. Good luck.

Is there any solution for these indents and other weird shapes in the bridge of my nose post revision rhinoplasty? (photos)

Answers (4)

Answer: Irregularities of dorsum after revision rhinoplasty

Answer: Irregularities of dorsum after revision rhinoplasty

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Everything you need to know about Revision Rhinoplasty

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Is there any solution for these indents and other weird shapes in the bridge of my nose post revision rhinoplasty? (photos)

Answers (4)

Answer: Irregularities of dorsum after revision rhinoplasty

Answer: Irregularities of dorsum after revision rhinoplasty

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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.