Can anyone help me to describe technically the issues with my nose after primary rhinoplasty 7 years ago? (photos)

I had primary rhinoplasy to remove my dorsal hump as I wanted to achieve a smaller nose. I am unhappy with my result, I feel I ended up with an unattractive nose that looks different from all angles . I want to go back to my surgeon now I have finished uni to ask why this happened when I was only having my bridge hump removed and would like help to describe the technical issues. I hope to have a revision at some point, but not with the same surgeon as I don't have confidence in him.

Doctor Answers 3

The tip's the thing, as your countryman Shakespeare might say.

The prominence of the tip, especially on that right three-quarters view, is due to the size and position of the tip cartilages, that don't seem to have been adequately modified in the first operation. Primary or revision, work on the tip of the nose is the most complex part of a difficult operation, by far.

See the "Web reference" link, just below my response. I made a couple of computer morphs of your nose, and animations of the morphs, to show the changes that are possible for your nose in truly expert hands.

I simulated narrowing and elevating the tip, mostly by further modification of your tip cartilages. The good news for you is that these photos seem to indicate that you have substantial cartilage remaining in your tip, so there is lots to work with. 

You should understand, though, that the changes I demonstrated in the morphs require very 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 determine whether your primary surgeon should perform your revision.

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'll change, and by how much he'll change them -- so you know whether it's enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. Then, he must show you before and after photos to prove that he can actually accomplish what he draws on the computer.

Omaha Facial Plastic Surgeon
4.8 out of 5 stars 41 reviews

My comments

These are your issues explained and the way to correct them:

-the dorsum is overally acceptable, except for the supratip area, the profile is good but at the supratip it is pinched and need broadening with spacer grafts, very tiny and short ones
-the main issues happen with your alar cartilages, which are in need in close-to-total rebuild and grafting
-pinched nose and pinched breathing valve, in need of substitutive cartilages
-lopsided tip with asymmetry of the medial cruras and domes, needing new cruras (this is partially cogenital and partially iatrogenic)
-retracted alar rims, needing caudal grafting of the lateral cruras
-cleft and broad tip, needing tip grafting Sheen's style

Your case is of high difficulty, but totally reparaible with expert hands and a delicate and artistic work.

Do research well about experts in rhinoplasties.

Alejandro Nogueira, MD
Spain Plastic Surgeon
4.9 out of 5 stars 44 reviews

Can anyone help me describe technically the issues with my nose?

Thank you for your question.

I would not expect any of my patients to speak to me in medical parlance. The best thing you can do is take the same pictures you have on this site and show them to your surgeon, pointing out the parts of your nose that you are not happy with.

Hope that helps.

Ivo Gwanmesia, FRCS(Plast)
London Plastic Surgeon
4.7 out of 5 stars 30 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.