Revision Rhinoplasty

Q: Dr. Eppley, I am interested in a revision rhinoplasty. I am currently 10 months post op and my nose is soft, I’ve been told that my swelling is gone and this is the final result.
Ive attached the post op report as well as collages of “pre op, post op, and desired revision” noses. Ive also attached photos of my pre op nose and post op nose from different angles. You’ll see that my surgeon blunted my tip and made it bulbous and higher than before. I’d like my nose returned to its length and sharpness. I look forward to your assessment.

A: Thank you for sending your pictures and the operative note. In regards to your revision rhinoplasty, your current nasal tip shape is the result of reductive cartilage techniques. (blunted higher nasal tip as you have described) Thus any effort to re-establish a more defined nasal tip that is longer will require infralobular tip cartilage grafting as an onlay technique. (there are other methods but this would be most effective) This will require cartilage grafts to do so. Since your septum has already been harvested I would not have confidence that re-entry would produce the amount of cartilage needed to get an effective result. This leaves either the ears or the rib. One or both ears would have the required cartilage needed to effectively do the procedure.

In summary the key to your revision rhinoplasty is to restore what has been removed which is cartilage. The grafts are needed to push out the nasal length and give it volume so the overlying nasal tip skin looks longer and somewhat sharper. Whether you can get back completely to where you started can not be predicted beforehand but this approach will come as close as you can be to your preoperative nasal tip shape.

Dr. Barry Eppley
Indianapolis, Indiana