What Seems to Be the Problem? (photo)

August 2012, I received my 1st septo/rhinoplasty by a surgeon who I think was not as skillfully trained to do so. She left a deep supra alar crease that worsens when I smile. I have never been insecure, but I'm definitely at my ultimate low right now. Is it possible its just swollen and it could disappear when I've fully healed? if not what are my options? what possibly went wrong during surgery? I REALLY do not want a 2nd surgery. I see her in 2 weeks I don't know what to say to her.

Doctor Answers 5

What Seems to Be the Problem?

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Problem is the over resection of the cartilage. Try a filler first to see if this improves the appearance. 

Deep alar crease issue

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Right now, you are probably maximally swollen. I would give it at least six months or longer to settle.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Deep alar crease post-rhinoplasty

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It may be still too early to worry. Changes could occur for up to a year or more as the tissues normalize. However, be sure to raise these concerns with your surgeon when you see her in two weeks. Following an examination, she should be able to explain what may be causing this condition and offer options for addressing it.

Good luck!

Post operative rhinoplasty

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This question brings up an interesting situation during the post operative course in rhinoplasty. Many times swelling will be so significant that the post operative result is effectively masked for some time. Generally speaking revision surgery is not considered until at least a year has gone by from the original operation. On the other hand major problems with a post operative result can be evident early on and in my practice it just doesn't make sense to make the patient wait a year to fix an obvious problem.

I recommend a frank discussion with your surgeon regarding whether or not this result is expected and what the surgeon thinks is causing this irregularity. In my experience patients sometimes focus on things that I know will go away on their own and simple reassurance can help them. But if there is a problem it is better to formulate a reasonable plan to correct it at the appropriate time (whether it be now or in the future).

Deep alar creases may herald another condition called cephalic lateral crura

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I know thats all medical speak. From the before photos, you already had deep alar creases. That is often caused by the tip cartilages being angled more superiorly than the standard 45 degrees. In that case, any reduction of the tip cartilages can make these creases worse. The best treatment is to support under the creases with cartilage grafts or relocate the cartilages to a lower position. Allow your nose to fully heal (one year) then if it persists, you may need revision. I'm not a fan of putting filler in that area as the skin is very tight.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

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.