What can be done with my nostril? 3 years post-rhinoplasty.

Question

I had a closed rhinoplasty almost 3 years ago with a popular surgeon in Glendale, California. My left nostril is much higher and bigger after my rhinoplasty. I asked my surgeon about a composite graft and he says it will not help but will make my nostril rim bulkier. I want a second opinion about the composite graft and/or other solutions to improve the nostril show. Thank you.

Steven M. Denenberg, MD · Answer

It's true that a composite graft to lower a nostril edge never seems to work quite as well as we'd like it to work, and it does make the nostril bulkier because of the cartilage that's added, especially in a nose with thin-ish skin around the tip, like yours.However, if it bugs you a lot, that leans us toward doing *something*, and there may be some other things to try. Here's an example:Your nasal tip, after surgery, is still very strong in its forward projection away from your face, and bringing the tip back toward the face might be good for a couple reasons. First, if you've noticed that, too, it would make your nose smaller, less prominent. But then, when a nose is smaller, any imperfections look smaller as well, a side benefit.Besides that, though, when a nose is brought back closer to the face ("de-projecting" the nose), it usually *looks* longer, as if the tip had come down some. So, in de-projecting a nose, we also usually elevate the tip a bit so the nose doesn't look too long after. But in elevating the tip, the columella (the piece that separates the left nostril from the right nostril) is brought up, and that can decrease the amount of the columella that is visible from the side, the thing that's bothering you now.Then more: the techniques that allow us to deproject the nose involve work on the two tip cartilages, and while those cartilages are exposed to de-project the tip, more cartilage can be added to the left tip cartilage, to allow it to project downward more, hopefully lowering the position of the edge of the nostril -- kind of like doing a composite graft from the inside of the nose. I find that's more work, but generally more successful than an isolated procedure to put in a composite graft.Hope this makes sense. I'm trying to give you a lot, based on only a couple of photos and your complaints and no physical exam, but your photos I think show the problem pretty clearly.
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 whether it makes sense to deproject and elevate the tip as part of making that nostril less prominent.

Thomas A. Mustoe, MD, FACS · Answer

Unfortunately there are no easy reliable solutions to lower an elevated nostril.   During the healing process from the original rhinoplasty the scarring process combined with partial resection of tip cartilages has raised the nostril.  Composite grafts have been successful but are unreliable in their outcome.   Formal revision rhinoplasty with strong cartilage grafts can lower the nostril usually but not always and can add bulk.   Sometimes filler or fat can slightly lower nostril and raising columella can disguise nostril show by reducing distance between nostril and columella.  I would consult with at least two surgeons experienced in revision rhinoplasty as well as your original surgeon

Gurkan Kayabasoglu, MD · Answer

Hello,Based upon your photos, you seem to have a hanging columella and alar retraction.You can benefit from lowering an elevated nostril and creating balance and graft material needed to be used fix alar retraction. You can have  balanced, natural result you desired.Piezo technology will provide you maximal healing as it protect all soft tissues during operation. You need to seek a professional facial plastic surgeon to obtaion your goals.

William Portuese, MD · Answer

The profile photographs demonstrate a hanging columella and alar retraction. A columella-plasty can help improve the amount of hanging columella, while a composite graft harvested from the ear can accomplish bringing the retracted alar rim downwards. The nostrils will never be symmetric, only improved.

What can be done with my nostril? 3 years post-rhinoplasty.

Answers (4)

Answer: What can be done with my nostril three years post rhinoplasty?

Answer: What can be done with my nostril three years post rhinoplasty?

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

What can be done with my nostril? 3 years post-rhinoplasty.

Answers (4)

Answer: What can be done with my nostril three years post rhinoplasty?

Answer: What can be done with my nostril three years post rhinoplasty?

Browse related questions

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.