Short Nose after Rhinoplasty

Q: Hello sir, I did my first rhinoplasty for a  minor problem.  Initially I had a thin and pointed nose but overall it was not too bad looking. I went to this inexperienced surgeon because me or my parents didn’t know anything about surgery at that time. He made my nose shorter with a  round tip and I got very bad dark circles under my eyes for a year. My nose is still short, fat and twisted.  After three years, I have gotten the courage to consider another rhinoplasty surgery to make it look better. What do you recommend to be done?

A: Most likely what has happened is a fundamental problem that is reminiscent of rhinoplasty  from days of old…removal of too much cartilage structure. This results in collapse of the nasal tip due to loss of support as well as wound contracture. Almost certainly, this rhinoplasty was done through an endonasal approach where  removal is what can largely be achieved. Only the real masters of rhinoplasty can do significant restructuring that has predictable outcomes through the limited access of the endonasal approach.

For a revisional rhinoplasty such as this, the open approach needs to be done. The tip cartilages and nasal septum can be separated, cartilage grafts placed and reshaping done through suture techniques. It may also only require an onlay cartilage graft but that must be precisely placed. Only the open approach offers this degree of visibility. The cartilage grafts will likely come from the ear (conchal) due to the size and shape needed.

At three years from the initial surgery, the nasal tissues are more than soft enough to allow for good manipulation and healing.

Recovery from the short nose problem in revisional rhinoplasty is usually quite good, but access and cartilage grafting are the keys.

Dr. Barry Eppley