What Techniques Are Needed For My Rhinoplasty To Improve Breasthing and Its Appearance?

Q: Dr. Eppley,I was born with a large nose and recessed chin and had rhinoplasty and chin implant twenty years ago.  The rhinoplasty left me with a bump so I had a revision several years later. During the revision he scooped out my slope and took a chunk of my ear cartilage and put it on the tip, and angled the whole thing up. You can now see inside my nostrils. He also narrowed my left nostril at the base and the right nostril now sticks out and up. The tip is kinda pinched-looking and my slope is gone. It does not fit my face and I can’t breathe properly. After the revision he tried to shrink the tip using a steroid injection called Kenalog (0.1 mL).  I think he tried to do the Barbie-style of nose. My left nostril wall is collapsed and I’ve recently found a huge benefit wearing breathe right strips at night. I’m now sleeping through the night and it’s amazing. Several years ago two stitches worked their way out through the tip area on the inside of my nose. That was scary. I feel like the entire nose is unstable. I’ve had a couple consults in my area and they’re not what i need… I need functional and aesthetic rhinoplasty. 

A: By your nose surgery and symptom description you have both functional airway and aesthetic nasal shape concerns. Positive improvement with the Breath Right strips demonstrates that there is internal nasal valve collapse +/- weak lower alar cartilage support. This often happens when the structural support of the nose has been over reduced. This is best approached by the combination of middle vault spreader grafts and batten grafts to the lower alar cartilages using septal cartilage grafts. Septum is the best source and it is unknown to me whether your septum has previously been harvested or not. (I suspect it hasn’t given that ear cartilage has been previously used) This functional surgery can be combined with the needed aesthetic changes which appear to be bridge augmentation, columellar support, tip scar removal and right nostril adjustment.

Dr. Barry Eppley

Indianapolis, Indiana