San Diego Revision Rhinoplasty Specialist

This San Diego revision rhinoplasty patient was thought to be a great example of revisionary cosmetic nose surgery and a good platform to discuss some of the details involved in this type of highly specialized surgery. She presented to our facial plastic surgery office with a request to have her nose reshaped further. Her history was significant in that she had undergone two prior nose jobs by other plastic surgeons. When you looked at her nose, it actually was not that bad overall. She is an attractive female who had some issues with the appearance of her nose, but it did not distract significantly from her overall look. However, she was bothered by some residual contour abnormalities with the nose and was willing to undergo further revision rhinoplasty surgery to get it to the point where she was happy. She chose to come to our office given my reputation as a San Diego revision rhinoplasty specialist. It just so happens that we revise a good number of previously unsuccessful rhinoplasty surgeries. When it comes to this type of highly complex, challenging surgery, there is no substitute for having experience and skill in performing revision rhinoplasty on a regular basis.

Revision Rhinoplasty Evaluation – Frontal View

On examination of her nose, the following were the features that we discussed and agreed would likely benefit from the revision rhinoplasty. On her front view, she was still a little wide for her liking. The red curved lines indicate the asymmetric (crooked) position of the nasal bones, which were positioned out to the side more than desired. We also discussed how she was slightly too wide at the upper portion of the nasal bridge as indicated by the blue horizontal line. In addition, she desired to have her tip a little bit narrower to give a more feminine overall look to her nose.

Revision Rhinoplasty Evaluation – Oblique View

On her oblique, or angled, view of the nose you can begin to see some issues she had with the bridge height. The white arrow indicates a notched scar that she had developed from her original rhinoplasty surgeon. The last facial plastic surgeon who did her rhinoplasty tried to improve the scar and was able to do so, but it was still in need of additional revision work. On this oblique angle, you can also see the red curved line along the upper dorsum, or nasal bridge, that indicates it is too high for her facial proportions. Ideally, the bridge height would be lower down to give her nose a more feminine, softer look.

Revision Rhinoplasty Evaluation – Side View

On the side, or profile, view of her nose, you can better appreciate what I was alluding to in the oblique view above. You can see that her bridge height is just a little too high for her nose and you can see the shadow from her notched scar. This happens to be a soft tissue depression along the area where her columellar incision was made previously to open the nose. Her nasal tip was also slightly ‘over projected’ still – meaning, it stuck out from her face a little too far. This latter finding was not real obvious to the untrained eye, but was something we had discussed in her revision rhinoplasty consultation.

Revision Rhinoplasty Recommendation

Once again, overall this wasn’t a terribly bad looking nose. As a revision rhinoplasty specialist, I have certainly seen noses in much worse shape following prior rhinoplasty reshaping by other plastic surgeons. In many peoples’ opinion, this was a rhinoplasty result that is fairly acceptable given the known complexities and challenges associated with nasal reshaping surgery. And, after all, her nose definitely had the potential to look worse with another revision rhinoplasty surgery. But the patient in this case was still bothered by her nasal appearance and wanted to have more reshaping of the nose. And I felt quite confident in my abilities as a revision rhinoplasty specialist that I could help her out. In the end, I recommended she undergo another revision rhinoplasty surgery to address many of the issues we just reviewed.

The Revision Rhinoplasty Surgery

We elected to perform another open revision rhinoplasty approach since one of the goals was to correct the notched columellar scar. In the process I was able to cut out her old scar and realign the edges so that the final result would be less visible. I then reduced her upper bridge height by sanding it down to achieve a more pleasing nasal profile. This was followed by a maneuver to break the nasal bones on both sides in an effort to reposition them. In doing so, this portion of the revision rhinoplasty procedure helped to narrow the nose as best seen on the front view. This also helped us to achieve more symmetry when looking at her nose front on. The revision rhinoplasty also included some nasal tip reshaping. This primarily involved reduction of her tip cartilage and an attempt to bring the nose back closer to her face.

Before And After Photos Revision Rhinoplasty

Here are her before and after revision rhinoplasty results. As you can tell, she has a nice overall improvement in the shape of her nose. Once again, she did not start off with a nose that was all that bad. I would consider this a type of ‘finesse revision rhinoplasty’ procedure since we altered the shape of her nose a little here and a little there to create a more enhanced nasal appearance. Her upper bridge is now thinner and shadows better plus her nasal bones are more narrow. This translates into a more feminine and symmetric frontal view. Her oblique angle now shows a more elegant looking nose with a softer appearance after revision open rhinoplasty. And her side view of the nose now shows a more fitting shape with better proportion compared with the rest of her facial features. We were also able to improve the notch underneath her nose.