Q: Dr. Eppley, Thanks so much for agreeing to do a revision rhinoplasty consult with me, I’ve followed you on Realself and I’m excited to get a professional opinion from someone who seems to be as well educated, concise, and thoughtful with answers as yourself.
I am a young female and in 2013 I had a primary septorhinoplasty to address some septum issues as well as improving aesthetically the dimensions of the nose. Pertinent to this first surgery, it might be noted that I have thicker and sebaceous nasal skin,and my septum was not visibly deviated prior to this first surgery.
Immediately following the operation, my nose was crooked, septum was deviated to my left and a year following that, my doctor recommended a revision in order to straighten it. That took place in 2015, and the goal for that surgery was primarily to straighten my septum and refine the tip/cut out some of the scar tissue that had formed.
After my revision which would’ve been close to two years ago now, my nose seems to have formed a significant amount of scar tissue and though I often use tape still for compression, my nose seems much larger, thus looking a bit more amorphous as well as still being deviated to my left side. Corticosteroids injected into my nasal tip were used about 3 times, starting 4 or so months after my revision up until about a year post-but none were used after my primary. I also did not realize this before a few months ago, but it shows in my operative notes that I had a graft placed.
My doctor has recommended a second revision full septorhinoplasty and suggested that he wanted to submit everything for insurance. A few months later I saw him again and during that visit he told me his plan for the revision was to straighten the septum and cut out scar tissue, which was basically the same goal as the first revision. I asked him what his thoughts on the use of steroids post op were and if he would be able to possibly trim the graft that he had already placed in the tip of my nose. He seemed particularly impatient about speaking with me and he just gave me a flat “no”. Further, I brought up something that he had actually told me before which was that my nostrils seemed a bit crooked, except this time he said that my jaw is crooked, not the nostrils. He recommended that in addition to my revision septorhinoplasty, he could do a reduction genioplasty to make my chin look more proportionate to my face. He told me that may help with the fact that when smiling, my upper central incisors don’t show, which makes my smile look not as full and suggested that he thought it would improve the aesthetically the proportions of my face.
My surgeon is a very well respected doctor in my area and specializes in septoplasty and rhinoplasty but I feel like it would do me well to get a second opinion from another physician to understand whether it’s worth having surgery and what my chances at success and options are. What I was hoping is that I could have someone look through all my pre/post op photos (I apologize for the quality, many were taken from my phone and many also have been redacted for privacy and taken from past posts in regard to my septum from the Realself website. I did, however, try to include a wide variety of photos in different lighting and angles to hopefully give a more clear visual), read the operative notes, and scan my xrays and help me understand
a. whether or not I’m a good candidate for either a secondary revision septorhinoplasty or
b. a genioplasty surgery, or
c. something else in addition or in lieu of those, that would in your opinion benefit my face aesthetically.
d. whether my jaw looks crooked and if it could be corrected
e. What your suggestion would be in regard to how to aesthetically improve the proportions of my face
Thanks so much for taking time to consider my situation and help me figure out the best course of action for deciding on my potential surgery. Looking forward to hearing from you.
A: Thank you for telling your surgical story and sending all of your pictures. In short, the answers to your questions are fairly straightforward.
1) Your nasal tip is crooked with nostril asymmetry. This is not going to improve without further surgery.
2) Your jaw, however, is straight.
3) Do not, under any circumstances, do anything to your chin. Your jaw is straight and you do not need a chin reduction. That will not aesthetically help your face. The focus needs to be on improving your nose through a revisional rhinoplasty.
Dr. Barry Eppley