Revision Rhinoplasty Disaster! Is it possible to smooth out my bridge? (Photos)

Question

I had my first rhinoplasty in 1999. It was a closed rhinoplasty. He broke my nose to narrow the bridge and the tip. In 2014, I got a revision because I had visible bones on my bridge and i had a bump on my profile. She took cartilage from my ear and put it on the bridge of my nose. She put spreader grafts in because she said I had an inverted v deformity. The graft and bones on the bridge are very visible. All I want is an even tip and a smooth bridge with a straight profile. Is this attainable?

Steven M. Denenberg, MD · Answer

Click on the "Web reference" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_Vert68.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that could be possible for your nose in truly expert hands.The changes in this morph didn't directly address your main complaints. What I did was to elevate the tip of your nose, and lower the little bump on the bridge, and then move the entire nose back closer to your face.Just smoothing out irregularities from so much grafting is very difficult to accomplish. If there were *other* changes that you wanted in your nose, however, it would help. For example, with the changes I showed, the height of the bridge would be lowered, and that gives us more of an opportunity to smooth out the irregular grafts, by possibly removing some of them as well. Also, if the nose is shorter, with the tip up, there is less length of the nose in which to notice any remaining irregularities. And finally, if the drooping tip bothers you as well, correcting that would also help in minimizing how much any graft irregularity bothers you.Of course, you don't have to have these tip changes. But I recommend a revision when the most likely outcome is enough improvement that it's clear that the operation was worthwhile. When the hoped-for changes, measured in millimeters, are small, as they are if the goal is only to smooth out the bridge, the chances of meaningful improvement are much less, and maybe it's not worth having surgery, and having something else, new, that bothers you. If the goal is a much larger change, such as if the tip is coming up, that can push the decision toward having surgery. Boy, I hope I described that well enough!
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 rhinoplasty surgeon, and how to tell whether your primary surgeon should be performing your revision. You should only have surgery if you are able to make yourself very confident in your surgeon's skills. Read that page very carefully. Most plastic surgeons are quite poor at this operation, and I believe my advice will go a long way toward keeping you safe.
I'd love to hear what you think of the morph. Did it seem to address your main concerns?
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 a beautiful nose, and whether he shares your opinion of what constitutes a beautiful 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. 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.

Bahman Guyuron, MD · Answer

It seems that your skin has become very thin and the grafts are very visible. Your nose can be improved by removing and replacing these grafts along with increasing the thickness of your skin. You may wish to consult a board certified plastic surgeon who has experience dealing with a similar tertiary rhinoplasties.

Deborah Sillins, MD · Answer

i are using more fascia grafts to help contour the nose better then cartilage because cartilage can wrap. Make sure you see a board certified plastic surgery

Steven Wallach, MD · Answer

You might consider filler in this case to help smooth it out. It would be temporary but could give you a nice result for many months at a time.

William Portuese, MD · Answer

Yes, a revision rhinoplasty should be able to smooth out the nasal bridge. Thin skin in the bridge of the nose can make it a little more difficult since every little nuance shows through. A tertiary revision round plastic is more difficult than a primary rhinoplasty, so choose your surgeon wisely based on extensive experience producing natural results

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