Am I even a good candidate for revision rhinoplasty? I'm worried that the damage from first surgery is too extensive.

Six years ago I had a consult with an ENT for my tonsils, but during he told me that I also had a deviated septum and that he could fix it AND straighten it for me all in one go. But after surgery it's now more crooked, my breathing is horrible, I have to sleep with my head elevated (otherwise it's too stuffy), and the tip is very hard & droopy. I'm apprehensive about more surgery because I'm afraid of making it worse, but I'm really tired of looking at it. Do I even have options at this point?

Doctor Answers 6

You appear to be a good candidate for rhinoplasty.

Dear careathompson in Ventura:  It seems to me it would be a worthwhile effort to have a revision rhinoplasty.  Straightening the deviated septum is appropriate for breathing.  If the nose is more crooked and your breathing is horrible, then you need to have revision septoplasty and perhaps even turbinate reduction.  You should look into this. You did not discuss much about the outside of your nose.  My impression from the photos is that can be improved also.  It seems like the nose is a bit too long, hangs down, probably depresses with smile, and has a curvature that is not satisfactory.  I do believe you are well served to think about your options.  You are young and presumably healthy and now is the time to have the revision and put the matter to rest.  You want to do your homework before consultation.  Prepare well for your consultation.  When you search, look for rhinoplasty super-specialists.  These are surgeons whose practice is the majority or entirely devoted to rhinoplasty, septoplasty, and related procedures.  This would include both primary and revision rhinoplasty surgery.  Why not have the most specialized talent in your service?  Consider how much experience the surgeon has doing the procedure you are considering. We all get better at what we do with time and so those surgeons who have a long run of experience are the ones who have learned the most from experience. Residency and fellowship are where the learning begins, but for all of us, time and experience is where the education continues. Part of your preparation for consultation should be preparing a list of questions beforehand.  Bring a notepad or ipad or laptop with you and take notes as the surgeon answers the question you are asking.  You should spend more time with the surgeon than with the office administrative staff, because you need to get a sense of whether you are comfortable with the doctor.  You should not feel rushed that you are on a consultation conveyer belt.  If the presentation by the office staff seems a bit to “salesie” that is a bit of a yellow or red light.  Take a friend or relative along since two heads are better than one in gaining information and understanding.  In the end, the purpose of the consultation is for you to be educated and be comfortable, not to be “ sold”.  Ask yourself two key questions: “Is this surgeon teaching me or selling?” And secondly, “Can I put my life and my face into this particular surgeon’s hands? Can I trust him/her?” There are excellent books out there that you can read and use to study up. It is worth the homework time you put in up front so that you make the right decision with respect to choosing a surgeon who has the talent, experience, and degree of super-specialization that you certainly want to have.  When you visit doctor’s websites, the most important feature on the site is the before and after gallery.  If there are just a few examples of rhinoplasty or revision rhinoplasty, you wonder how much experience the surgeon has performing such surgeries.  There need to be dozens and dozens of examples.  The more examples there are, the more likely you will see one or more that demonstrate situations similar to yours.  Look closely at the photos for natural results.  That is what you want.  Nobody wants to carry a sign saying “I have had a rhinoplasty.” Reviews on review sites, particularly RealSelf are very important and should be carefully digested. The larger the number of reviews the most accurate the picture of the practice and particularly the doctor. A consensus is generally correct. A consultation without computer imaging is, in my opinion, of much less value.  Why shouldn’t you see the predicted result of the procedure the doctor is proposing?  At consultation, photos are taken of you and loaded into a computer system that morphs your present appearance into the anticipated “after” based on the nasal surgeons input.  Imaging is an incomparable learning tool because it provides a forum for doctor and patient agreement on what would satisfy the patient and what is, in the doctor’s opinion, achievable.  After all, cosmetic surgery is 100% visual.  It is about appearance, so without a visual evidence of what is planned, how can you make a decision as to whether or not you might be satisfied.  Talking about it is worthless.  To anticipate a successful outcome, there must be a meeting of the minds between surgeon and patient. Best wishes, Robert Kotler, MD, FACS Over 4,500 nasal procedures performed


Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 83 reviews

REVISION RHINOPLASTY CANDIDATE

Dear careathompson, You are still an excellent candidate for nasal surgery and should have a very nice result in the hands of a skilled surgeon. You will require a septorhinoplasty  to address the function and aesthetics of your nose. The "septo" portion will help straighten the nose and address the breathing concerns. While the "rhinoplasty" portion will also address straightening the nose, but will improve the aesthetics as well by reducing the dorsal hump, tip projection and width. I would seek consultation with some experts in the field of rhinoplasty, have imaging performed to show you the proposed results and then review the surgeons before and after photographs to ensure natural looking noses. See the link below for examples of  before and after photographs and the video above of a similar looking nose. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 198 reviews

Excellent candidate for revision rhinoplasty procedure

Reduction revision rhinoplasty is usually easier than adding a whole lot of cartilage grafts back to the nose to restore form and function.  Look for a double board certified ENT/facial plastic surgeon with extensive experience in rhinoplasty for best results to breathe better, and improve the look cosmetically.  Revision rhinoplastyis one of the most difficult procedures to perform in the entire field of cosmetic surgery, so choose your surgeon very wisely based on extensive experience.  Digital computer imaging performed by a rhinoplasty specialist  is an excellent communication tool to understand what can and cannot be accomplished with your nose. For many before and after results, please see the link and video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Vision rhinoplasty for crooked nose with unsatisfactory cosmetic result.

I can understand why you are dissatisfied with your results. If you see a very experienced rhinoplasty surgeon who is proficient in revision rhinoplasty and produces natural looking noses you should have a very good result. The breathing obstruction you have with septal and nasal deviation can be correct  along with grafts to improve the midportion of your nose as well as refining your tip and correcting your hanging columella  removing the hump etc. Look at results of the surgeons before and after pictures at their website. You can see noses worse than yours with excellent results on  my website as well as others. Make a consultation with several and discuss your goals. Do not rely on imaging but rather on the surgeons actual results. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 32 reviews

Am I a Good Candidate for a Revision Rhinoplasty?

After reviewing the pictures you submitted combined with the description of your breathing problems I  feel you are an excellent candidate for a revision.  You have a deviated, asymmetrical long nose with a moderate hump, poorly defined tip, and hanging columella (the strip between your nostrils). A revision rhinoplasty specialist can improve both the appearance and nasal function at the same time. In fact some of the unwanted physical characteristics you see and don't like are contributing to to your obstruction.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Revision Rhinoplasty Consultation and Nasal Valve Collapse

You are an excellent candidate to consider a revision rhinoplasty and possible improvement for your nasal breathing and stuffiness. Your photos suggest that your nose is indeed crooked, too long, full in the bridge, concave in the upper lateral cartilage area (valve) on the right and your tip is too droopy and amorphous. An evaluation by an experience, reputable Facial Plastic Surgeon should lead to recommendations about exactly what is going on that the best way to correct your nose for improved appearance and function. I would consider an open approach revision rhinoplasty with cartilage grafts. You have correctly outlined your concerns and in my view, you should not have to live with persistent nasal issue when corrective, expert surgery is available. Select someone who regularly performs revision rhinoplasty and ask to see example of their patient results. With the right physician, you should do well. Best Regards

Fred J. Bressler, MD, FACS
Houston Facial Plastic Surgeon
5.0 out of 5 stars 7 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.