Desperately want some help! Revision rhinoplasty needed, asymmetric tip and twisted cartilages. Advice?

Question

I had primary rhino/septoplasty 1.5years ago, I've attached my surgeons operative notes. When I woke I could immediately see that my right nostril appeared 'hiked up' and unnatural. I could feel a dent also that runs from the nostril rims into the centre of my tip. This dent has become v obvious now that swelling is gone and one of my nostrils looks as if it's gaping as the rim sits high. The cartilages look twisted, buckled and warped. My surgeon wants to revise but can't tell me what is wrong.

Lucian Ion, FRCS · Answer

Your surgeon's notes indicate several possible points of failure but in fairness this would only become clear during surgery.
The history of septal cartilage fracture means a higher risk of instability when it is reconstructed just with cartilage graft from the septum. 
It is also possible that the columella strut is relatively short, because of difficulty in harvesting sufficient cartilage in the context of the previous fracture. 
At present, the nasal tip appears significantly distorted to the left, with torsion rather than leaning and this is more likely due to insufficient support. This tends to be corrected well by additional support.
For many surgeons rib cartilage would be more likely graft material to control the problems described in your operation notes.

Gurkan Kayabasoglu, MD · Answer

Hello, Based on your photos, your unevennes issue can be seen, you sem to have depressions on your dorsum. However, an in-person examination can make certain assessments. Your issues can be all addressed to a revision rhinoplasty. You can improve your failed surgery's result, more balanced, straight and symmetric nose you can have.To heal faster and protect your soft tissues, Pieze Technology is state of the art. You need to seek an expert facial plastic surgeon.

Steven M. Denenberg, MD · Answer

I say that mostly because of the op report and the pre-op photos of your nose in an earlier post. You had strong, prominent cartilages in the tip of your nose, and from the op report, the surgeon discovered asymmetric tip cartilages, but did almost nothing to them. If that's the case, it leaves lots of opportunities to modify them further.In situations like this, I like to make the nose smaller, too, if it fits with the patient's tastes. It's never possible to completely correct asymmetries, but if the asymmetries sit on a smaller nose -- a shorter nose with a narrower tip -- then those asymmetries aren't as noticeable and they tend to bother us less.And in general, making things smaller can be fairly predictable. The woman in the short video that I posted with this answer had the tip of her nose elevated and narrowed in her revision operation.
With some profile and three-quarter views, we could make some morphs. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. (Side note: in my opinion, morphs should always be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and only the surgeon has that information and judgment.)
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, requiring skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.
Your nose is also a perfect 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. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Richard Mark Winters, MD · Answer

...in gaining confidence that any surgeon can fix your concerns begins with an accurate assessment of the problem and then a reasonable anatomically based description of how they are to fix it... you appear to have reasonable cartilage remaining and haven’t been over-resected, but clearly what’s remaining is unsupportedTake your time finding an appropriate expert and visit at least a few surgeons so that you can get a feel for who really knows what they are talking about...Good luck...

Desperately want some help! Revision rhinoplasty needed, asymmetric tip and twisted cartilages. Advice?

Answers (4)

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