Revision Rhinoplasty: alar retraction and high bridge/radix, should I consider shaving it down?

Question

I had (closed) tip Rhinoplasty several years ago. Not sure the results were Better than the side effects. Alar retraction on right side is the worst. I will post a before Rhinoplasty and after. The bridge wasn’t touched. However I’m curious is shaving down the radix is something I should consyin the revision. I don’t want to jeopardize structure, and will that possibly create a flattened/shorten nose? Thank you for your valuable time.

Steven M. Denenberg, MD · Answer

Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_Sophielacoq.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.
That full radix makes your profile take on the look of a Roman statue:
FacialSurgery.com/RealSelf/RomanStatue.jpg
and it makes the nose look long. Long being measured from top to bottom.
In the morph, I deepened your radix, and then also elevated the tip and brought the tip back closer to your face. You'll probably see the changes best in the animation.
See if you think the morph captured some of what you're looking for.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon, and read the essay on how to tell whether your previous surgeon should be performing your revision. Rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. For most noses, it's better to not have surgery than to have inexpertly-performed surgery.
I'd love to hear what you think of the morph. Did it seem to address your main concerns? I could modify the morph to your taste if you wish. Perhaps leave the nose a bit stronger? 
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?! But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned, and how they fit together, and who can actually accomplish them in surgery.

Thomas Trevisani, MD · Answer

In order to evaluate most accurately - especially when it comes to revision Rhinoplasty- in person exam is essential.Based on limited photos- it appears that further improvements can be achieved - in the right hands.

Fred G. Fedok, MD, FACS · Answer

You present a situation with a great but not infrequent dilemma .  I have no idea what your nose looked like before.  It is now "pretty" good.  "How good" depends a little on where you started.  The finer points of where things stand depend further on what your personal aesthetic concept is, your height and other aspects of your appearance.  But lets just go fo some anatomic based speculation here.Hypothetically. if you were my patient, and wanted to get further refinement, I would go where the chance of success would be the highest.  I would address the lower third of your nose and bring your alar-columellar proportions into better balance.  This might be corrected with shortening your nose and/ or bringing your alar rims down a bit.  An exam would show me what would be most productive.  In doing that, I would also have the axis of your ala align better with the axis of your columella.Your concern about your bridge is valid, but somewhat subtle and I cannot adequate judge on the basis of these pictures. The goal would be to get your dorsal height and tip projection into best harmony.Be cautious and prudent!  My first point advice is to work with your original surgeon.Be well and best regards,Fred G. Fedok, MD FACS

William Portuese, MD · Answer

A revision rhinoplasty can accomplish reduction of the high radix, and this will involve shaving down the entire dorsal bridge line. Osteotomiues will also be required to be placed in the nasal bones. There is no alar retraction present, just a hanging columella which can be addressed with a columella-plasty. cap for many examples of closed rhinoplasty, please see the link in the video below

Kailash Narasimhan, MD · Answer

Thank you for your photos—for the retraction there are a few options including cartilage grafting. This could be done without significantly altering the rest of the structure of your nose. An in-person examination would be necessary to look at all of the angles and make this determination.  Internal and external nasal exam would be necessary. Good luck! SincerlyKailash Narasimhan, MD

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Revision Rhinoplasty: alar retraction and high bridge/radix, should I consider shaving it down?

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