Q: I had rhinoplasty over one year ago for a small bump on my nose and a tip that I thought was too wide. While it looked absolutely perfect for a few months, an indented area on the right side of the bridge of the nose appeared. When I brought this to the attention of the plastic surgeon, he told me to let it continue to heal and wait and see what it looks like at one year after surgery. I just saw him earlier this week and, although that indent is still there, he said it is not worth trying to improve it and I should just live with it since the rest of the nose looks fine. Do I have any other options at this point?
A: Like all forms of plastic surgery, the risk of a less than perfect result afterwards always exists. Rhinoplasty surgery is no exception and secondary aesthetic deformities are not uncommon. The risk of the need for revisional surgery in rhinoplasty is estimated by some to be 10% to 15%, although that risk varies based on the difficulty of the initial nose problem.
In my Indianapolis plastic surgery experience, I find that the dorsum or bridge of the nose is one of the most common areas where irregularities can eventually appear. It is the least precise area in rhinoplasty because it is the least visible and involves bone edges. Because of small amounts of persistent swelling and the months that it takes for the skin of the nose to shrink back down and adapt to the modified underlying bone and cartilage framework, any asymmetries of the bridge area will usually take three to six months after surgery until they become visible.
The recommendation to wait until one year after rhinoplasty before considering revision is generally a sound one. The reason is two-fold. First, you want to be sure that the area that needs to be improved is a ‘stable target’ so to speak. Because of the length of time it takes for all of the swelling of the nose to go away, operating too early may underestimate what needs to be done. Secondly, the nose needs to soften up so that dissection is easier once the scar tissue has settled down. While this is usually one year or so after surgery, a better estimate is how the nose feels. If it is still stiff, it is too early. It should feel soft and flexible again for the best revisional results.
Dorsal irregularities may only need to filed or rasped to smooth out a rough edge, but often indentations require some form of graft augmentation. Many graft options exist but I prefer diced cartilage because it is both a natural and easily moldeable augmentation material.
Dr. Barry Eppley