Q: Dr. Eppley, I am interested in a revision rhinoplasty. My first rhinoplasty was two years ago and the I had a revision a year later. I have difficulty breathing through my nose. Attached are many photos of my nose as well as two pictures of men – I find their noses especially attractive. I would ask for a nose with similar features. Other surgeons have told me that I have the following problems:
1.) dorsal hump
2.) tip reconstruction to have better tip shape and projection
3.) internal valve collapse – both nostrils are collapsed (seen in
4.) nostril shape asymmetry – alar notching deformity on the left
side. To fix with alar cartilage graft
5.) deviated septum/nose not on my face straight
6.) My own opinion – nose is too over-rotated. Would like it titled down so that nostrils and tip are more in alignment – making a straight line expression – NOT tilted toward the ceiling.
Very difficult problems. Essentially, all across the board, I have been told that I will need rib cartilage to rebuild my nose as it is horribly damaged. Overall, I would want a more functional, symmetrical and more proportional nose to my face. Again, some cosmetic and functional issues.
A: In regards to your nose and revision rhinoplasty, suffice it to say that it is a difficult challenge. While there are many technical maneuvers in your revision rhinoplasty, the key is adequate cartilage grafts to be able to achieve just about any of them. Your nose is completely collapsed and needs to be rebuilt using cartilage grafts. How successful that can be done depends on the stretch of the scarred nasal skin as it must expand to the underlying rebuilt nasal framework. Without question a rib graft would be needed to supply the graft material.
Dr. Barry Eppley