Revision Rhinoplasty

Q: Dr. Eppley, I am interested in another revision rhinoplasty. Are some noses by virtue of skin thickness or other unfavourable pre existing qualities simply not amenable to improvement? I have had 5 rhinoplasties already (the last procedure was done using autologous rib cartilage for the tip and silicone for the bridge. This was in march last year) and have seen little (if any) improvement in the size of my nose (which has always been my chief complaint). After the last procedure, ironically, I seemed to have ended up with an even bigger nose than what I had to begin with. The tip is now also drooping and the nose is long and heavy looking. Is there any hope at all for a smaller and more refined nose? My ethnicity is Asian but I do not think my skin is thicker than what would be considered typical for my demographic. I am willing to treat my nose as aggressively as is required so I can obtain the best outcome. I understand this may include taping the nose every night for the first 3 months and also kenalog injections for swelling / scar tissue resolution. In your practice, how beneficial have you found these adjunct therapies to be? Will/can laser help in thinning the skin to obtain a better rhinoplasty outcome?

A: Due to skin thickness, there are some noses where the ability to truly make it smaller or more refined is very limited. I would think after five rhinoplasties (four revision rhinoplasty surgeries) that has probably become true for your nose..even though I have never seen it. Regardless of what your nose’s original skin retraction capabilities were, that skin shrinkage capability is now probably lost. I do not know what the objective of your last rhinoplasty surgery was, but by adding rib cartilage and a silicone implant I can not see how it could have ever gotten smaller. By adding volume your nose would have predictably gotten bigger.

At this point I would not think that any amount of taping or steroids after a revision rhinoplasty is going to make your nose any thinner. That would be hard to imagine after so many revision rhinoplasty procedures. Laser is not a treatment for thinning the skin of the nose. There is no such procedure for doing so.

Dr. Barry Eppley

Indianapolis, Indiana