Questioner: Why is my Nose Crooked After my Rhinoplasty?
I am going in for a reconstructive surgery from my same doctor to save money, but have some hesitations and concerns that he will not be confident in fixing this problem: 2 years post op and would like to get experts opinions on why my nose healed crooked (was not crooked before!) Is this common? What should I ask him when I see him? Also feel like the tip juts out and creates quite the hard triangle angle in pictures. How can that be fixed?
(Questioner submitted photos)

Dr. Denenberg's answer: Re-evaluate your surgeon before you let him perform your revision.
Rhinoplasty is the most difficult of the facial plastic surgery operations. By far. And revision rhinoplasty is ten times more difficult than a first-time operation. And most surgeons who perform rhinoplasty probably shouldn't be doing the operation. It's not a commodity -- every surgeon doesn't perform the operation with the same skill.

Certainly, something can go wrong in any operation, even in the very best of hands. And having your primary surgeon perform the revision definitely saves money. But. You need to know whether things went wrong because of some unusual circumstance with the surgery or the healing, or whether things went wrong because your doctor was not expert in rhinoplasty in the first place. You need to evaluate your surgeon again. If you saw lots of before and after photos of other patients of his who got excellent results, in noses at least somewhat similar to yours, then your surgeon probably knows what he is doing, and you can consider letting him perform your revision.

However, if, on looking back, you find that you did not do excellent research on your surgeon -- you relied on a referral or some board certification without looking at his photos, the actual quality of his work -- then you probably should not have him perform the revision. If he couldn't get you close to your goal the first time because of a lack of skill, he will have no chance at all on the second try, and it will make it much harder yet for another surgeon to do the third operation.

The fact that the tip of your nose is still long and strongly protruding from your face is good and bad for you. It's good because, in my experience, raising the tip of the nose and bringing it back toward the face are two of the more predictable changes to make in a revision rhinoplasty. Also, when the tip is raised and deprojected, it gives more ways to correct the asymmetry, whereas generally asymmetries are difficult to correct.

It's not so good for you, because I find that most of the revision rhinoplasties that I perform are because of inadequate tip work in the first operation -- the tip is too long or too projecting. That might be a clue that your doctor is not the one to perform your revision.

Hope this helps. I know, it's a long response, but I wanted to get it all down because it might help someone else, too.

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