How Can My Rhinoplasty Results Be Improved?

Q: I had a rhinoplasty last year of which I am not too happy about. The bridge was shaved too low and I do not like the tip. It looks fat and pinched to me. I have attached a front and side view of your nose so you can see the problems. I would love to see what kind of improvements you think should be made! Thank You.

A:  I have looked at your nose and my thoughts are that you have a fundamentally over-resected nose that was done too aggressively. While it may have looked good initially, the nose is now collapsed and contracted inward at the bridge and upward at the tip. In short, you have excessive hump reduction, an inverted v deformity due to nasal bone collapse, an over-rotated and pinched tip and excessive nostril show. In days of old, this type of problem was more commonly seen. Today it is more uncommon as the emphasis on rhinoplasty has been on conservation of structures and not simply removal.

To improve this nasal deformity, the nose needs to be done through an open approach with the nasal tip de-rotated, the bridge and middle vault built back up and the nostril rims grafted. This requires cartilage grafts which, most likely, can come from the septum and ear but may require rib cartilage to get the best amount of graft material. I have attached some computer predictions which demonstrates the objectives. This is a difficult recondary rhinoplasty problem but good improvement can almost always be obtained.

Dr. Barry Eppley

Indianapolis, Indiana