Too much nostril - Do I need a revision? (photo)

Question

I had a rhinoplasty in April 2022 to remove a dorsal hump and refine the nose. It seems that my doctor just removed the hump and didn’t really do anything else. I feel like it should have been deprojected and now I’m left with large nostrils and a low columella. They didn’t show this much before. I really hate it. I voiced my concern at my one year follow up and my doctor just dismissed and said it was fine. Is there any way to fix this or is a full revision needed?

Kyle Kimura, MD · Answer

Thank you for the question and the photos and I'm sorry that you are dealing with issues after your rhinoplasty. 
I agree with your assessment, that your columella seems to hang a little bit which gives the appearance of a larger nostril, particularly in the first photo. On top of that, the rim of the nostril may be just a bit high. Sometimes you can see this during the recovery period after surgery from swelling, but now that you are almost 3 years out, I think this is less likely. I think unfortunately a revision rhinoplasty is likely the best option to get the results you want, however I think these are definitely attainable in the right hands. Your best bet is to schedule a consultation with a rhinoplasty surgeon well versed in revision rhinoplasty who can walk you through the process.
Hope this helps and best of luck!Kyle Kimura, MD

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 nasal tip deprojection, placement of extended alar contour grafts to treat alar retraction, slight tip elevation, among other maneuvers,. 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

Eric M. Joseph, MD · Answer

If the issue is a hanging columella, surgery may be necessary to raise it. If you would be happy with a few millimeters of nostril lowering, microdroplet Silikon-1000 nasal injections may be considered for decreasing nostril show - without additional surgery. Hope this helps! Sincerely, Dr Joseph

William Portuese, MD · Answer

You do have a residual dorsal hump, and a hanging Columella and wide nostrils. A revision closed rhinoplasty can accomplish shaving down the residual dorsal hump, reducing the hanging Columella, reducing the projection of the nose and an Alar plasty to reduce wide nostrils. All of the incisions are placed on the inside of the nose, and no painful packing is required either.

Too much nostril - Do I need a revision? (photo)

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