Q: Dr. Eppley, I had a nose job six months ago from which I am not at all happy. It was a closed septorhinoplasty with the objective of lifting the tip of my nose and narrowing it. While right after surgery the tip was up, it fell down just weeks later. My nose is now not only pointing downward but is bent to the right to boot. I am very unhappy. The doctor told me that the stitches either became loose and weren’t strong enough to hold it up. What should I do now?
A: One of the problems with a closed rhinoplasty is that it can be more difficult to get idelal tip shaping and rotation. This is not to say that it can not be done but it takes more experience to do so than in the more commonly used open rhinoplasty. There are numerous reasons why a tip does not get or sustain adequate rotation including a suture retention issue, inadequate caudal septal reduction, inadequate columellar tip support or some combination. Regardless a revisional rhinoplasty procedure will need to be done through an open technique now because of internal scarring and a failed first procedure. As long as this approach is used, you should be confident that you still can get the end result that you initially desired.
Dr. Barry Eppley