Are My Goals Realistic For A Revision Rhinoplasty?

Q: Dr. Eppley, I’m looking to get a revision rhinoplasty to fix facial asymmetry and improve appearance. My goals are to straighten my nose and decrease the amount of tip projection. Can you take a look at the attached document which shows some computer imaging and let me know what you think? Thanks!

A: Thank you for your inquiry and sending your goals. One of your nasal goals ia achievable, the other is not. Straightening a nose, particularly after a primary rhinoplasty, is always a challenge but potentially achieveable. Correcting the deviated nose would require a complete septoplasty and grafts to stabilize the realignment from an open rhinoplasty approach by separating the upper lateral cartilages from above for access. Shortening the nasal tip projection by the amount you have shown is not a realistic goal. While the cartilaginous framework can be shortened that much, the overlying skin is not going to contract down that far. And if one tries to reduce the support for the tip skin by that much, the tip skin is likely to end up with a ball-like deformity. It is far safer and more realistic to settle for a 1/3 or perhaps 1/2 that much reduction to avoid intractable tip skin problems.

I make these comments as general statements without knowledge of what was done during your primary rhinoplasty. Knowing those structural changes may change the aforementioned opinions.

Dr. Barry Eppley