Plastic Surgery 101

Patient unhappy with how nose looks after rhinoplasty. How to fix?

Q: I had my nose operated on and it still looks very wide. I’m not happy because it is also crooked. It’s been over one year and the doctor tells me that that’s the best he can do. What do you think I should do?

Carlos Wolf 2018
Dr. Carlos Wolf

A: You need to get a second opinion. It is not uncommon for patients who’ve had rhinoplasty to be unhappy with their results. I see a significant number of patients who have had surgery with other doctors and they are still not happy. It is not always necessarily due to what the doctor did but to the miscommunication between what the patient wanted and what the doctor gave the patient. It is for that reason that I often try to give my patients a rendering through photo imaging to understand what they want and what I can deliver.

Your initial complaint of your nose being too wide indicates to me that your doctor took the bump off but did not perform osteotomies (breaking of the bones). When your doctor removes the bump and does not break the nose, the nose appears to be wider than it did before the surgery. In addition, you stated that your nose looks more crooked. This indicates to me that your doctor may have tried to do osteotomies but did not complete them. When this happens, the nose will appear to be crooked because one side is completely broken and the other side is not. This often happens with a physician who is not very experienced in rhinoplasty and only performs a few a year. The good news is that there is a solution for your problem. I just operated on a patient who had the exact same problem.

Your physician will have to do an operation called revision rhinoplasty. Revision rhinoplasty surgery should only be done by physicians highly trained and skilled in this type of surgery. These surgeries are often more difficult than a primary (first-time) rhinoplasty. You will likely need to have your skin elevated over your nasal bones and repeat the osteotomies in order to break your bones and straighten your nose.

If not enough of the dorsum had been removed you might have to have a revision of that as well. Very often, doing that along with minor touches on the tip will make your nose look like you originally wanted . My suggestion is that you find a physician who is well-versed in revision rhinoplasty such as a facial plastic surgeon or a plastic surgeon who specializes in rhinoplasty surgery. Make sure he has the ability to image you on a computer so that you and your physician will understand and come to a consensus as to what your results will be. Good luck.

Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board-certified. Email your questions to him at Cwolf@miamiplasticsurgery.com. Follow him at @CarlosWolfMD.
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