How Can I Fix My Nose Asymmetry After My Rhinoplasty?
Q : I recently had a rhinoplasty approximately 3 months ago. The purpose was to make my nose more symmetrical (nose was crooked due to getting hit in the nose 10+ years ago) and smaller/narrower. I consider the results (as I see the nose today) as somewhat of an improvement, but I believe that better results (potentially much better) are possible. Furthermore, I am not 100% certain, but I believe that the results were better the day I got the cast off than they are today (could be my imagination though).
A: Thank you for sending your photographs. My first general comment is that the details of a rhinoplasty often don’t become revealed for several months after surgery. While all areas can look great right after the splint is removed, asymmetries may appear in the tip or bridge as the swelling subsides over the next few months. As I tell my patients, we will not have a victory parade until 3 to 6 months later when the final results will be seen.
In looking at the pictures and reading your comments, the issue is that of the asymmetry of the upper part of your nose from the position of the nasal bones. There is an asymmetry of the nasal bones after osteotomies, the right is more infractured (and perhaps more thoroughly osteotomized) than that of the left. The asymmetry is probably a combination of positional issues on both sides, the right nasal bone is in too much and the left nasal bone is out a little far.
Correction could consist of further infracture of the left nasal bone and onlay augmentation of the right nasal bone. Outfracture of a nasal bone is unpredictable in stability.Ideally, cartilage is the best onlay material but an adequate piece in size may not be obtainable from the septum. (based on your previous surgery) An alternative onlay option is a thick piece of allogeneic dermal graft.( available in 2 and 3mms thickness)
Since it has been three months, I suspect that what you see now is the way it will be. A revisional rhinoplasty could be done in the next few months, about six months after your initial surgery.
Dr. Barry Eppley