What is the best approach to fix my nose? Reconstructive rhinoplasty (Photo)

Nov.1st 2015, I had reconstructive facial surgery due to most of my facial bones being crushed by my boyfriend. 5 metal plates fixed my cheeks, eyes and forehead but my nose was completely shattered into pieces. They couldn't do much besides make it easier for me to breathe again. My nose is very sloped inwards. I hate the way it looks and would like it to look similar to the way it looked before. I don't want to go through my nostril or septum because it's so fragile already.

Doctor Answers 12

Reconstructive Rhinoplasty after facial Trauma

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Dear smccray36, First of all I should apologize for a surgeon below who asked why you would let someone touch your nose? Obviously you did not intend to have your nasal bones crushed by domestic violence and this was not a choice you made. I do believe that the only way to rebuild your nose would be with an open approach surgery with grafting. I would suggest that you seek several consultations with experts in the field of rhinoplasty surgery. If you have any operative reports from the previous trauma surgery to your nose these would be helpful for evaluation. In patients with these domestic violence situations it is helpful to try and achieve the same look you had pre-trauma. We understand as surgeons that everyday you look in the mirror and you see the signs of that violence that it is harder to recover from. There are certain victim funds you can look into that may help finance your procedure. Wishing you the best. Michael V. Elam, M.D.

Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Rhinoplasty options

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Sorry to hear about your past domestic violence and injuries.  Returning your nose back to its prior shape and height/size will require adding cartilage.  I suspect the best and likely the only way to definitively and significantly correct your nose injuries is through an open approach using rib cartilage.  Anything short of that will likely not fully correct your nose shape/size issues.  Non-surgical rhinoplasty can increase the bridge height but not by the amount that you desire and it will be temporary.  A closed rhinoplasty approach can be used to add diced cartilage grafts to the dorsum/bridge but I suspect you can also benefit from the support of adding cartilage via an open rhinoplasty approach.

I hope this helps.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Reconstructive rhinoplasty

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I'm really sorry for what you had to go through.  To me it looks like the surgeon who did your work did an excellent job.  You have a slight saddle deformity of your nose which can be corrected with a cartilage or Ben graft in the bridge of your nose to build it up.  Many different ways to accomplish this that work very well.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Rhinoplasty after trauma

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Rhinoplasty is frequently necessary after trauma. The potential causes of the changes in the appearance of your nose almost certainly relate to a change in the support structures of the nose. To correct these issues, you will likely need to have structural support added to the nose. This is typically done with cartilage from the septum, rib, or ear. Please be sure that you see a surgeon experienced in rhinoplasty surgery, because your case is more complicated than most.

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 50 reviews

Nasal Reconstruction after Severe Trauma

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You will need cartilage grafts probably taken  from your ears and ribs to reconstruct your nose improving the underlying structure, support and shape. You need a thorough examination and review of your records but definitely need to increase the length of your nose and augment your depressed profile.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Yes, the height of your bridge can probably be elevated.

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See the "Web reference" link, just below my response. I made a computer morph, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands. I simulated putting material in your nose to elevate the height of the bridge.

You have a very pretty face, and some great facial features, and nasal features, too, so you would want the minimum done to get you back to a reasonable range of normal.

Don't let someone over-fill your bridge. Don't make it too strong. That would open you to more possibility of complications, and for sure you don't want to think your nose is too *big* after surgery.

Also, 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 "Web reference" link on how to stay out of trouble while searching for a revision rhinoplasty surgeon.

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 42 reviews

Reconstructive rhinoplasty

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Thanks for your question. So sorry to hear about your injury. Glad to know you're in the healing process. Yes, a reconstructive rhinoplasty would be the way to go. In my hands, you'd get cartilage grafts that would push your nasal tip down and provide structure for the middle third of your nose. I'd probably also give you an onlay graft to build up the nasal profile again. Honestly, you'd probably need rib cartilage for this kind of work. The AAFPRS has an outreach program where facial plastic surgeons provide services to battered women. You might consider looking into it. Good luck.

Robert S. Schmidt, MD
College Station Facial Plastic Surgeon

Nose reconstruction

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I am very sorry to hear what happened to you. Now that some time has passed they may be able to do more for you and the best surgeon to fix your nose is likely the one that fixed your fractures. You definitely need augmentation of the bridge but the best way to do that is through the nostrils. The deficit is so large that I think most surgeons would not feel comfortable only injecting filler to augment your bridge.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Nasal reconstruction after trauma #plasticsurgery #rhinoplasty

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You appear to have a depressed dorsal profile and other consequences of a severe and complex facial fracture. Reconstruction of your nasal profile will likely require a rib cartilage graft - this graft source is abundant, can be carved to shape.

Reconstructive rhinoplasty

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The only way to increase your nasal dorsum without surgery is by use of fillers which is not permenant. Any other procedure requires access through nose and does not need to be through septum. One possibility is use of nasal implants which have been used for millions of patients with relatively low side effects by those surgeon who have had experience with this. It fast, quick and will achieve smooth dorsum. Use of bone from scalp is also a possibilty as well as rib cartilage. These latter techniques are obviously more invasive and again with experienced hand can achieve a good result. Use of nasal implants is probably better choice if you do not want a very invasive procedure but one of the down side of this is, not many rhinoplastic surgeons are familiar with its use and dismiss it for lack of experience. Good luck and wish you best.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.