What Type Of Revision Rhinoplasty Do I Need To Fix My Crooked Nose?

Q: Dr. Eppley, I am of African descent and I want to improve the shape of my nose and make my lips smaller. Sadly in my attempt to reduce the size of my upper lip and nose I ended up with a crooked nose and lips. The worst part being that my lips remained just about the same size. 

A: My assumption, based on your pictures, is that an implant was placed in your nose since that is about the only thing that can make the nose deviate like that after a rhinoplasty. When trying to improve a nose shape like yours (originally), the fundamental principle is one of a strong columellar strut to support the tip and a good dorsal augmentation. While an implant can be used for the dorsal augmentation, it should never be used for the tip-columellar support as it has a high propensity to deviate…just like yours has done. (not to mention placing the skin over the tip of the nose at jeopardy for vascular compromise) You need a good cartilage graft for support for your revision rhinoplasty and this almost always requires a piece of rib to do so. The implant may be able to be salvaged and used, but once you need a rib graft for the columella you might as well abandon the implant and go with a completely natural graft approach. There are other additive techniques that can be done, such as nostril narrowing, but the dorso-columellar buildup (augmentation) is the key.

From a lip reduction standpoint, if the tissue removal amount and location is not just right, a minimal result is seen and scar contracture can result in the lip. Since you already have a linear contracted lip scar, that would serve as the posterior (inner) incision location with a more aggressive excision done out on the anterior (outer) vermilion. It is the vermilion which needs to be reduced if any size reduction is to be obtained.

Dr. Barry Eppley

Indianapolis, Indiana