Is possible to fix a crooked nose placing fat?
I had a revision rhinoplasty. A graft was used to fix the over resected dorsum, but this is now moved to the left, I think it is too big for my nose, because I can feel it almost almost in my forehead, between the eyes brows. Is it possible to fix it placing my own fat and make it look not so crooked or is necessary to go under a third rhinoplasty?
Fat grafting to the face has now become a standard of practice for most plastic surgeons. An examination will be required to answer your questions. Please consider one of the many members of the ASAPS in your area for a consult. Make sure to take copies of your previous surgery's operative reports and possibly some old photos to assist the plastic surgeon in making an accurate determination as to the most appropriate restorative procedure for you. Best,
Gary R Culbertson, MD, FACS
I have used fat injections a number of times for my revision rhinoplasty patients,and they do work. However, they are not the best solution for the problem that you describe. In your case, the skeleton is still not right--too large and asymmetrical. I would recommend a revision to correct the skeleton.
Where fat grafts work best are in situations where the skeleton is good but the skin is damaged and very thin, so that the grafts are visible. Here. the fat can thicken the skin and produce a smoother result.
Remember also that fat grafting is surgery itself, so that you are not avoiding an operation by having them done instead of a formal revision.
Each nasal revision gets harder. Make sure that you find a very experienced surgeon whose results in cases like yours you like. Good luck.
Revision Rhinoplasty and the Use of Fat – A temporary way to camouflage a crooked nose may be to use fat, however, it is not very effective. A hyaluronic acid filler may be more effective and is what I prefer. Certainly, both are only temporizing to cosmetically camouflage the deformities. Also, it does not correct the functional part of a crooked nose which would be correction of the septal deviation and internal nasal valve deformity.
Fixing a Crooked Nose Using Fat – One cannot permanently fix a crooked nose using fat and/or filler, but you can camouflage it partially. If you truly want to fix a crooked or deviated nose then you need atrue rhinoplasty. Not only can this correct the problem of a crooked nose functionally, but aesthetically as well.
Is it possible to fix a crooked nose placing fat?
What is paramount is seeking an experience rhinoplasty surgeon for any additional revisions. Evaluation to determine the best option for correction should start with a full nasal exam by an experienced expert who is certified by the American Board of Plastic Surgery who is ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) or an ENT doctor certified by the Board of Otolaryngology. It may be useful to bring in prior photos as well as fully discussing your desired outcome and what is realistic. There are many options available and fat has a role as a filler for mild depressions. It is generally thought that 50-70% of the fat remains permanently. Fat, however, is not adequate if you need additional structural support which would require cartilage or bone grafts. If a cartilage graft was placed and is too big or displaced, it may require a revision or trimming of that graft rather than just placement of fat which may make the nose look larger. Healing may take longer to occur in a revision rhinoplasty.
There are permanent synthetic fillers,,but they have significant greater long term problems and I would not suggest using them in the nose.
Robert Singer, MD FACS