Fourth Rhinoplasty - Sheveport, LA

Beginning in puberty, my nose grew larger with a hump on the bridge. I had my first rhinoplasty when I was 18 years old right before graduation in 1990. I am going to have my third rhinoplasty revision surgery in October. After my first surgery, the tip began to turn to the right. I had already moved out of state and decided to live with it for the time being. In 2002, I needed sinus surgery and asked the ENT to try and fix the tip. He did. It healed fine and yes it was better/straighter. In 2009, I broke my nose in an accident. At the time, I didn't know it was broken. When it healed, it looked much the same way as before. I decided to have an upper eye lift in 2012, and consulted with a PS about a rhino revision also. I explained my history and asked for a cute, less conspicuous looking nose. In post op my dr. said there was a lot to repair from my accident and he had even used cartilage from my right ear to build the tip up as he did not have enough left from my previous surgeries. After I healed, it was straighter but had a very similar look and the tip seems to have fallen over time. I feel like if he would go smaller and scale down my nose there would be less chance of a curving in the bridge and/or the tip. I am even wondering if the asymmetry is due to my bone structure. The left side of my face is a little underdeveloped compared to the right side. You can really tell this in my jaw line, my eyebrow and my ear. Can the mid-line of my face be causing shifting and curving of my nose? Should my PS reinforce my nose with something extra? I am going to consult with him again before my surgery and ask him these questions. Is there anything else I should ask him? I have noticed in 99% of the rhinoplasty post op photos there aren't drastic changes such as in length or depth of the patients nose. Is there a reason? Am I expecting too much if i ask him to make my nose smaller? He has said by raising the tip, it will give the appearance of bring smaller. I would like the depth and length of my nose to be scaled down in addition to raising the tip. What do you think? I am also having my ears pinned this time too as my right ear sticks out from the lack of cartilage.

I have added a picture of my nose in 8th grade before any surgeries and one after the first rhinoplasty.

So happy I had Dr. Sanders redo my nose. I had a ton of scar tissue that was removed and he lifted the tip! I love it!