Mark B. Constantian, M.D., FACS
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.
When performing a rhinoplasty, how do you determine the correct shape of the nose?
The "correct shape" used to depend on aesthetic norms and Renaissance ideals of beauty. These ideas are falling away as it becomes obvious that many patients do not have noses that will look right if those standards are followed.
It is much more important to me what the patient wants. Are there familial, ethnic, or personal characteristics that must be preserved? Is there symmetry? Is the airway optimal? Can nasal proportion be better? Does the patient want more angularity in the nose or less?
All of these answers must be part of any preoperative discussion between patient and surgeon.
The tip of my nose drops somewhat. This makes me feel uncomfortable as my profile looks really weird. Can the surgeon just lift the tip of my nose slightly upward without doing a full rhinoplasty? Also, would it be cheaper to do just the nose tip?
Yes, most areas of the nose can be changed independently. If your tip droops, you have inadequate tip projection, which is correctable (I use tip grafts through a closed approach).
You must, however, consider nasal proportion when you speak to your surgeon. Your nose must look balanced, and that may mean doing small things to your bridge to keep balance optimal.
I'm a young teenager and I hate my nose. I am sure about needing and having nose reshaping. Nothing anyone will say can change my mind. I want to know if there is any way that my nose will change within the next few years. Should I wait until I am 18 to get Rhinoplasty?
Age is not as important as emotional and physical maturity. There are 14 year old young women who look and act 20, can articulate their goals, and cooperate with the dressings and stresses of surgery; and there are adults who cannot do so. I will operate on the mature, cooperative patient who knows what she wants and can understand and cooperate with the plan, and also understands that surgery, surgeons, and patients are not perfect.
When you are ready, find an experienced surgeon who can show you results of noses that look like yours that you like - and a surgeon whom you trust.
I had rhinoplasty 25 years ago and was never really happy with the result. I would like to have a second rhinoplasty, but now have deep puffy bags under eyes. If I were to get a lower blepharoplasty and then have rhinoplasty six months to a year later, would the rhinoplasty stretch out the skin below my eyes?
No--they are unrelated areas. You could even have the procedure performed at the same operation.