Q: Dr. Eppley, I am interested in a secondary rhinoplasty surgery. I was just reaching out in regards to a prior septorhinoplasty surgery I had done. I am now one year post op and am not happy with the changes hang have been done to my nose shape. The changes that were done made my profile different and my nose appears shorter in height and length and not as wide. Cosmetically I am not happy because it is smaller and does not fit my face. My concern is that my nose appears wider but its actually thinner by bridge and middle of nose, its length is shorter due to the upturned tip, the nasal base and tip is a little smaller, and height isshorter due to dorsal hump being taken down. My goal is to restore to original height, length, and width like it used to be. Can cartilage be added to upper and middle of nose to make width wider again? Can nasal bones be out fractured to help increase width? During revision can bones be reshaped? Is this possible if osteotomies were used previously? Can fascia be used to add some volume back to nose and appear softer? The goal is to have nose appear more natural and not such harsh lines to look like a nose job has been done. In addition my nose seems to be congested more now than before. Any recommendations for tests to see what is going on?
A: In essence you are describing a secondary rhinoplasty to build back out the nose making it closer to what it originally was with emphasis on dorsal and tip augmentation as well as nasal bone widening. While there is no ‘returning home’ in an exact way so to speak, improvements can be made to augment the nasal areas that were reduced as well as place spreader grafts in the middle vault to improve breathing.
The key to doing so comes down to one basic need…you have to have enough cartilage graft to do so. For this type of nasal reconstruction (rhinoplasty reversal) you really need a cartilage rib graft to do so. (aka rib graft rhinoplasty) That supplies all the necessary cartilage graft to build back out the nose.
Dr. Barry Eppley