What Type of Revision Rhinoplasty Do I Need?

Q: Dr. Eppley, I am in search of a very skilled revision rhinoplasty surgeon and am impressed by your work. 

I had my first septorhinoplasty with right inferior turbinectomy around 18 years ago.  My nose looked wide and had bulbous tip and pinched nostrils on birth and I had breathing problems. During first surgery the doctor took too much of my bridge away. My breathing problems got a bit better but my nose looked totally deformed.  I am of course very depressed due to that and am very much judged by people in life when they see me before I even open my mouth due to my appearance. 

I long to have a normal nose, I would like to have my bridge built up.  These pictures were taken in 2012 just before tip plasty.  I am sending the same pics to you for evaluation as the doctor did not even touch the bridge, only the nasal tip (hook) noted on left profile was made smooth, but everything is the same no difference at all. I did not want my bridge touched at that time as I thought things will get worst but am prepared now to take the plunge with the right surgeon. 

I was told that I did not have any septal cartilage left for grating but never had ear or other cartilage or implant used so far.  What do you think could be done to improve my nose? I do not want any synthetic implants in my nose, thus the only option is my ear or rib cartilage? 

I want to have an elegant nasal bridge, and have the pinched nostrils look better and start to live life better. I would be ever so grateful for your feedback.

A: In looking at your pictures, you do need a dorsal augmentation by a cartilage graft and a rib donor source would be the best and really only good choice in your revision rhinoplasty. This provides an adequate amount and shape of the dorsal augmentation that you need. You would also benefit by alar rim grafts to provide improved support to your nostril rims so they do not collapse downward. Slivers of rib cartilage graft would be an excellent source of the straight thin grafts that are needed here.

Dorsal augmentation would bring the upper two thirds of your nose in better balance/proportion to the tip.

Dr. Barry Eppley

Indianapolis, Indiana