Mark B. Constantian, M.D., FACS
I had revision rhinoplasty after my tip had been over-rotated. I was told that my ear cartilage may be used. While under anesthesia, bone grafting from the septal spine (septal cartilage) was used to create a bridge, and the bone between my eyes was split fracturing into my orbital and up to my eyebrow through my supra-orbital notch. Is there ever a case where this would be necessary? I'm in pain, feel fluid from my left eye that travels through my nose and settles in the back of my throat. Thanks for your time.
It is of course impossible for me to advise you accurately without examining you and understanding what the surgeon intended. If you are asking if a fracture through the nasal bones into the orbit and the bone between your eyes (which I take to be the frontal bone) is normally done in rhinoplasty, even revision surgery, the answer is no.
You do need to be examined by a surgeon experienced in facial aesthetic and reconstructive surgery. It is very likely that you can be helped.
I wish you the best.
M. B. Constantian, MD
Several years ago I had my deviated septum fixed. It is possible to now get a nose job? I have heard they use your septum to do the nose job, but since having deviated septum surgery, haven't they already removed my septum?
It is absolutely possible to have a rhinoplasty after having had a septoplasty. How easy that will be depends on what you need to make your nose look better, and what your septoplasty actually was. Some surgeons remove the obstructing part of the septum--others manipulate or score it, but leave the cartilage and bone in the septum. In general, it is easier to do the rhinoplasty if you have septal cartilage left, though ear cartilage can be used if grafts are needed and the septum is unavailable.
Find a knowledgeable surgeon whom you trust and who can give you expert advice. Performing a rhinoplasty when the septum has already been dissected can add complexity to the planning, so make sure that your surgeon is experienced in such cases.
Best of luck!
M. B. Constantian, MD
I had a nose job 5 weeks ago. After a week I realized with HORROR, that my nose bridge was huge and that I had a hump. I never had a hump. With no more swelling on my bridge I see the implant fully: sides, top and how misshapen and larger than necessary it is. My PS is not telling me how he can fix it. Can this be rasped under local anesthesia? Can I go to a different surgeon? Also, how long do I wait? I feel my skin stretching, I am scared.
Removing, reshaping, and replacing a calvarial bone graft is not hard if it it done skillfully by an experienced surgeon. I have had to do it on my own patients occasionally. Therefore, do not worry. I have never seen such a graft come through the skin, which seems to be one of your concerns..
You must, however, wait long enough for the tissues to soften so that the revision will be maximally successful. If the dorsal graft is very bad, I have revised it in 6 months but done nothing else. If you can wait a year, that is better. Make sure that you see someone who does this surgery often--the graft is there for a reason.
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?
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.
I have a cleft lip/palate which also affected my nose. My nose on one side is deflated and the other side is larger.
I have a bone graft that builds up my nose so it is not flat. It goes to the tip of the nose. It causes me discomfort and the tip of the bone is apparent thru my skin. I want to have my nose reconstructed and the bone graft taken out. Is it doable to put fillers in the tip to make it look like a nose and to reconstruct the deflated side to match the other side so it will be more symmetrical?
There is one major problem with your current reconstruction. The bone graft should not extend into the tip. Surgeons often try this technique to support the tip, but normal tips do not get their support from the bridge but rather from the tip cartilages, which allow the tip to be mobile.
Asymmetry is the rule in cleft noses. Your surgeon has made a good beginning, and if the bone graft is otherwise fine it can be shortened and cartilage from the ear or septum can be used to fix the tip independently. That, plus whatever other procedures you need for your cleft shape, will make a big difference. If the bone graft looks like it may poke through the skin, you should get advice sooner rather than later.
Find an experienced surgeon whom you trust and whose cleft results you like. Good luck.