Revision Rhinoplasty Before & After: Correcting a Droopy Tip and a Polly Beak Appearance

Revision Rhinoplasty #33

Our beautiful patient came to us for revision rhinoplasty, due to dissatisfaction with her nasal appearance after a primary rhinoplasty that was performed in 2017. She had a fairly common problem that may develop in people, if a rhinoplasty surgeon does not place adequate cartilaginous tip support during the time of rhinoplasty surgery. She developed a droopy tip and a polly beak appearance. A polly beak is when the bridge of the nose sticks out further than the tip, and this tends to be associated with a droopy tip. Additionally, our patient had nasal obstruction from a severely deviated nasal septum, and an overly wide appearance with lack of tip definition on front view, and tip droopiness with smiling. The saving grace was that the previous surgeon did not touch her nasal septum, so all grafting material that was necessary to support and refine her nasal tip was utilized from her own nose, not frozen cadaver cartilage, which is sometimes necessary. We corrected her deviated nasal septum, narrowed her nose, deprojected and rotated her tip for a less distracting, better breathing, and more feminine nasal appearance without stigmata of previous rhinoplasty. We are most grateful that she has allowed us to post her stunning photos.

Revision Rhinoplasty Before & After: Restoring Nasal Function and Symmetry After Prior Surgery

Revision Rhinoplasty #32

This is an example of an early post-operative appearance, 5 months following a complex, functional and cosmetic revision rhinoplasty surgery. Our patient was dissatisfied with the appearance of her nose after previous rhinoplasty, and she also sustained nasal trauma which led to a more crooked nasal appearance, and nasal obstruction on both sides.

From a functional standpoint, when I explored her, she had mostly all of her lower lateral cartilages completely removed by her previous surgeon. This was causing severe external nasal valvular collapse, when she would breathe in. Additionally, you can see irregular points of cartilage involving her nasal tip and these are called bossae. She also had an open roof deformity, an inverted V deformity, and a crooked nasal tip appearance, due to a severely deviated nasal septum. There was also an exaggerated curvature from her colimella to her tip which led to an overrotated nasal tip appearance - all stigmata of previous surgery. Fortunately, her previous surgeon never performed septoplasty, so there was a plethora of her own cartilage for me to reconstruct her nose.

Goals were to reconstruct her nasal airway, and to provide a less distracting, and less operated looking nasal appearance. Her internal nasal valves were repaired with spreader grafts on both sides. Her external nasal valve collapse was repaired with lateral crural strut grafts. We achieved a straighter nasal base appearance by correcting her severely deviated nasal septum, and by using a columella shoring strut graft.

After surgery, you can see a more natural looking nasal appearance that doesn't call attention to itself, and we are all grateful that her nasal airway is reconstructed, and she is breathing perfectly. I am beyond grateful that she has allowed us to post her photos.

Revision Rhinoplasty Before & After: Addressed Crooked Nasal Appearance, Nostril Asymmetry, & Nasal Obstruction

Revision Rhinoplasty #31

Our beautiful patient is seen one year after complex revision rhinoplasty surgery using MTF (Musculoskeletal Tissue Foundation) rib cartilage. She had a previous rhinoplasty performed by another surgeon about a year before meeting us, during which all useful, graftable cartilage was removed from her nasal septum. The previous surgery resulted in a severely crooked nasal appearance, nostril asymmetry, and nasal obstruction. In our surgery, we deprojected the lower third of her nose and corrected the base of her nasal septum with a left septal extension graft. Her airway was supported with lateral crural strut grafts, which were also used to address her nasal tip asymmetry. Additionally, we placed a columella shoring strut graft for structural support at the nasal tip and narrowed her nostrils. We are so grateful that she has allowed us to share her photos. She now has improved nasal breathing, and her nose appears straighter and more natural, with a less "operated" look.

Revision Rhinoplasty Before & After: Repaired Hanging Columella, Deprojected Tip, & Removed Profile Bump

Revision Rhinoplasty #30

Our beautiful patient is seen one year after tertiary revision rhinoplasty surgery. This means she had two previous rhinoplasty surgeries before we operated on her. She presented with both functional and cosmetic concerns. She was unable to breathe through her nose due to external nasal valve collapse, which was associated with a deviated nasal septum and enlarged turbinates on both sides. From a cosmetic standpoint, she disliked how much her nose protruded on profile (overprojected), as well as the leftward tilt of her tip, which resulted in a crooked, operated appearance. In her postoperative photos, we can see a straight nasal profile from the front view and a deprojected nasal tip in profile, giving her a less distracting, more feminine appearance. Her repair involved bilateral lateral crural strut grafts to maintain airway patency and restore nasal tip symmetry. We also repaired her hanging columella, deprojected her tip, and removed a small profile bump. We are so grateful that she has allowed us to share her photos!

Revision Rhinoplasty Before & After: Tip Deprojection and Tip Rotation

Revision Rhinoplasty #29

Our beautiful 30-year-old patient presented to our office with functional and cosmetic concerns after previous rhinoplasty surgery. She was dissatisfied with the appearance of her profile because her nose was persistently long and her tip was overprojected. Additionally, she had significant droopiness of her nasal tip both on profile and front view with smiling.

From a functional standpoint, she had difficulty breathing through her nose because she had both internal and external nasal valvular collapse. The goals of her surgery were to downsize the appearance of her nose with tip deprojection and tip rotation. Her functional nasal airway collapse was corrected with bilateral, lateral crural extension grafts, and bilateral spreader grafts, and correction of her severely deviated nasal septum. Her photos were taken one year after her revision rhinoplasty in our practice. Not only is there a more feminine and less distracting nasal appearance, additionally, she breathes much better. We are so grateful that she allowed us to post her photos.

Patient Review:

“Dr. Joseph did an amazing job with my revision rhinoplasty! I was so unhappy for years after my first rhinoplasty and was worried about trusting another surgeon to fix my nose. Dr. Joseph really understood exactly how I wanted my nose to look. He also fixed all the issues inside my nose that were obstructing my breathing. Overall, going with Dr. Joseph was the best decision I ever made, I wish I did it sooner!”

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