Candidate for Revision Rhinoplasty? (Photo)

Question

Hello, I had one rhinoplasty about eight years ago. It quickly became clear it was not a good result aesthetically or functionally as I have difficulty breathing. I started getting filler about two years ago to smooth out what was possible on the bridge but one nostril is notched and the whole thing is off to one side. I would appreciate any feedback as to whether a revision is possible or if it could make it even worse. Thank you for your time.

Steven M. Denenberg, MD · Answer

It depends on what we want to change, how predictable it is to change the issues, and by how *much* we want to change them. For example, if we want to change something by a very tiny amount (tiny when measured with a ruler, not tiny by how much it bugs you), it's harder, because we can never hit something 100% on the target: if we wanted to change it a lot and we miss by a little bit, we still got a big improvement. If we want to change it a teeny-tiny amount and we miss by a little bit, well then, maybe we didn't do anything at all.
To my eye, your tip looks somewhat prominent. When it comes to the bridge, *feeling* the bridge would help, because irregularities of cartilage (hard stuff( are usually straightforward to smooth out, but irregularities of skin thickness, or scar tissue clumps (soft stuff), are much harder. 
Also, centering a nose on the face can be very hard. Asymmetries are hard to address, especially if they are small-ish unless we find something correctable that is specifically causing lots of the asymmetry.

How *much* to narrow the tip, or change the bridge, or make other changes? We figure that out with morphs, well before surgery. 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 better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really 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 the surgeon has that information and judgment best.)

Finally, 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, and skill that most plastic surgeons don't possess with expertise. 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 it also discusses how to take photos that are best for online evaluations.
And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Ruslan Zhuravsky, DO · Answer

Hello, Yes you would be a candidate for a revision. This is something I see frequently with revisions. You have convex lower lateral cartilages. They require more complex and advanced techniques to treat correctly. Because of the convex curvature of the cartialge, they remain round and the lateral (outer) part pinches inward, creating what we call "re-curvature" into the nose. Please make sure to see a well qualified rhinoplasty expert. Make sure that in your consultation they acknowledge the convex cartilages and offer a solution of how they will treat them. I prefer to elevate them and use cartialge from the septum, ear, or rib to flatten and support them. This also allows me to de-rotate them in the process. You don't have to fully understand the exact explanation they give you, but make sure it makes sense and centered around flattening and supporting the curved cartilages. Do several consultations to compare explanations. Good luck!

Dean Toriumi, MD · Answer

Hi Nee Nee 1,
Thanks for posting your question along with the photos. Based on what I see currently, I believe you would benefit from a revision rhinoplasty. This would have the benefit of improving the form and function of your nose while providing long-term structure that will last the rest of your life. It's my personal belief that in order for a rhinoplasty to be successful it must provide the patient with a durable, attractive, and well functioning nose. Feel free to reach out to me and my team to schedule a virtual consultation if you are interested in discussing things further.

William Portuese, MD · Answer

As long as you have reasonable expectations, there is room for improvement on your nose. Just remember, it will never be perfect. The dorsal irregularities across your bridge line can be smoothed down, and the notched nostril can be improved as well with a composite graft from the ear. The attachment of your ala on the left is much higher than the right, and you were born that way with facial asymmetries. That cannot be improved. Choose your second surgeon wisely based on extensive experience.

Candidate for Revision Rhinoplasty? (Photo)

Answers (4)

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