uneven nostrils and crooked nose after 2 revision rhinoplasty

I have had 3 rhinoplasties.  I am still not happy with my results. My first rhinoplasty left me with a very upturned nose. This made my nostrils very visible and at that point i noticed my left nostril was slightly larger than my right one.  I never noticed this before my surgery so I am not sure if it was always like that or if it happened because of surgery.  A few years ago I went in for revision rhinoplasty.  I was concerned over my nostril asymmetry and my upturned nose.  It seemed like the right side of my nose was collapsing also.  The doctor said he could make my nostrils even, and that he was going to put cartilage to support my collapsing side (rightside), and bring the tip of my nose down.  Well I noticed that he put the cartilage on the left side of my nose, which in my opinion didn’t need the support.  This created the nostrils too look even more uneven.  It also changed the shape of my left nostril, it is more rounded and my right is more flat.  He did bring the tip of my nose down.  But my nostrils are very asymmetrical and different shapes.  My left nostril is larger and more opened up because of the cartilage graft inside.  My breathing is also blocked from the cartilage graft.  I cant breath from my left nostril.  Last year I went in for yet another revision the doctor said he would correct this.  He didn’t, I still have the same problem.  My nose looks very crooked in pictures, I never take any front view pics because of this.  The crazy part is he is awell known and well respected surgeon.  He is also super nice and I just don’t know what to do now.  I am so unhappy with these results and now I cant breathe.  He mentioned something about injecting something to dissolve the cartilage.  Is this a good idea?  Please help should I have another revision with this doctor???

Doctor Answers 2

Revision Rhinoplasty Pitfalls

There is a reason that Revision Rhinoplasty is often called the most challenging plastic surgery procedure: It is frequently fraught with less than desirable results, and new unintended problems can appear that weren't present after prior surgeries. The normally soft & supple nasal skin and deep tissues are replaced with dense scar that has memory and doesn't take kindly to manipulation.  Often, there is also a second surgical site for the harvesting of cartilage to aid in the reconstruction of the nose, and 2nd site surgery means a bit more discomfort and a bit more time to heal.  Moreover, the pace of healing after revsions can take a LONG time. 

The picture you show indicates a twisted midvault, with a depression on the right side of your nose.   Although the nostrils appear reasonably symmetric in the front view you show, I CAN see some narrowing of the nostril on the right side which is undoubtedly making your nostrils look different in the base view.  It also sounds as though you are breathing poorly too, so you certainly have reasonable issues that would require protracted follow up and discussions how to proceed.   Your doctor sounds like a reasonable sort and undoubtedly understands your displeasure with the outcome.  I think it would be beneficial for the 2 of you to have a solid discussion about your nose when its completely healed (18 months or so after revision), that might very well include a recommendation for a 2nd opinion with someone he thinks is a revision rhinoplasty expert.  You might very well have to bite the bullet and pay another surgeon big money for a revision if you and your current surgeon feel that going to someone new is advisable.  This would require rib cartilage grafting to achieve, and an additional 18 months or so of healing.  Also, were you instructed to perform nose exercises after surgery?  These are very important in helping to "train" the nose to heal appropriately.  And do NOT forget the overarching principle of rhinplasty:  "Its about Improvement, not Perfection!"  You might need to come to grips that your nose will probably NEVER look exactly the way you'd like, but it can hopefully be closer to what you want than it is currently.  Good Luck! 

Baltimore Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

Uneven Nostils and Nasal Deviation

In the picture you submitted there is uneven nostrils, nasal asymmetry and deviation of your nose. There is also more flare of the left alar rim with  a scar in the left nasal base. I  feel you need more than simply trying to dissolve cartilage because this will not correct all of your problems and improve nasal breathing. I suggest you get a second opinion frm an experienced revision rhinoplasty surgeon.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

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