2 years post - Asymmetry in multiple areas including the bridge, tip, and nostrils. Should I have a revision surgery? (Photos)

Question

I had my rhinoplasty procedure done 2 years ago and I am disappointed with my results. The main concern has to do with overall asymmetry in multiple areas including the bridge, tip, and nostrils. The tip feels very large and droopy still, even after 2+ years. My nose feels so long, but I understand that just might be my anatomy and I can accept that. I also notice when I smile one nostril comes up a little higher and I am left with a weird bubble or pocket of skin forming on the right side of my nose/the picture. At the 1.5 year mark, my surgeon injected one side with a steroid and the other side with filler in hopes to help with the asymmetry. It has now been 2+ years since the surgery and 4 months since the filler/steroid and I don't feel like it helped. My doctor agreed and is now suggesting that we do an in-office procedure where he breaks the nose to help with alignment. Is this commonly suggested and regularly performed? Should I consider this option or would I be a better candidate for revision surgery? Or do I just leave it alone at this point. Any insight is greatly appreciated. Thank you.

Steven M. Denenberg, MD · Answer

1)Fixing asymmetries that are small-ish (small in how big they are to a ruler, not how much they bother you!) is just exquisitely difficult, and rarely works well.
2) From these photos, I don't see any asymmetries that "breaking the nose" would fix.
3) I never do "in-office" procedures. You don't have the anesthesia, and the control, and the time to make predictable changes.
The clincher is that you said that your nose is still large and droopy and long. That is typically *not* something that you have to live with because of your "anatomy." Elevating the tip, in particular, is one of the more predictable changes to make in a rhinoplasty, even in a revision. (You didn't post photos that showed the length of your nose -- those would be 3/4 and profile views that show your entire head) When the tip is elevated to your liking, the asymmetries that you currently see would probably be moot--they would be different, or they would change into other small asymmetries that bug you, but if they're on a nose that is overall smaller, then they are smaller, too, and they probably would bug you less. Also, during a real revision, if there *were* some technique(s) to specifically address an asymmetry, that technique would be much more likely to be successful.

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 straightening the tip, 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.
Harvard-trained plastic surgeon

Best wishes and good luck.

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

2 years post - Asymmetry in multiple areas including the bridge, tip, and nostrils. Should I have a revision surgery? (Photos)

Answers (2)

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