What Needs To Be Done For My Revision Rhinoplasty?

Q: Dr. Eppley, Hello, my concerns are a very asymmetrical nose from a prior rhinoplasty. I have been afraid of redoing it through the years and having worse results, but as I age, it becomes more and more obvious to me. I also have concave temples (I once had a blend of heart shaped/oval) but now have a peanut like facial shape, with my left eyebrow sagging worse than my right one. I also notice it increases the sagging of my outer upper eyelids, so when I relax my facial features I look grumpy or unhappy when I’m not at all! 

I would like these two issues for sure. Id like to have more addressed but my nose and my temples are my highest priority, I’d like to find out how expensive they may be, including a generalized idea of How extensive would my nose repair might be? I have hanging columella and alar retraction for sure. I am not looking to have the “perfect nose” but I would like it more symmetrical and when I use my muscles to pinch my nose downward and push up on the columella it looks so much better with allowing my eyes to be more visible (except for the alar retraction is also still visible with pig-like nostrils lol.)

I am a medical professional so I fully admit I’ve researched all the procedures and watched several informative surgical videos of these procedures, as well as multiple reviews of surgeons across the country. So I am most interested in the cost and the potential of how extensive these procedures might be for my situation and how much vacation time off from work I’d be required to have. Thank you so much for your time!

A: Thank you for your inquiry, sending your picture and detailing your concerns. From a primary standpoint the permanent treatment of temporal hollowing are temporal implants. Like many women you need the extended design and the only debate is what thicknesses they should be. (4 and 6mms are the options of which most women usually get 4mms) For your revision rhinoplasty based on your picture and description most if not all of the issues are in the tip area. It appears that it is a combination of hanging columellar correction (caudal septal resection and columellar strut), alar retraction correction (alar rim septal grafts), and tip defatting/scar removal and possibly some tip rotation. My assistant Camille will schedule  a virtual time to discuss further if you would like as well as pass along the cost of such surgeries.

Dr. Barry Eppley

Indianapolis, Indiana