Dr. Steven Denenberg's facial plastic surgery before and afters: Rhinoplasty, combination noses #7

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In these photos we see another clue, that his nose is over-projecting. In the after photo, draw these two imaginary lines: a mostly-horizontal line drawn along the base of his nose, and a line drawn along the skin from the base of his nose down to his upper lip. Those two lines meet at a sharp angle. In the before picture, however, they don't. The line that traces the skin of his upper lip curves forward to meet the bottom of his nose in the before photo.

If you grab the tip of your nose and pull it forward, making your nose more projecting, your upper lip skin will do the same thing. When the upper lip skin pulls forward like that, we call it "tethering of the upper lip," and it's usually an indication that the nose is a projecting nose.

The rhinoplasty section of the Surgery tutorials contains a chapter that discusses the phenomenon of upper lip tethering (the surgery tutorials contain explicit photographs taken during surgery).

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All views of this rhinoplasty patient:

rhinoplasty 1: Right oblique	rhinoplasty 2: Left profile	rhinoplasty 3: Left oblique	rhinoplasty 4: Right oblique

rhinoplasty 5: Left oblique	rhinoplasty current: Right profile	rhinoplasty 7: Base

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Questioner: I am considering a revision rhinoplasty. I am not sure if it is even an option for me.
First surgery in 1988. Closed procedure. Left me looking deformed, cartilage collapsed. Second surgery, different surgeon tried to repair with closed procedure. Nothing changed. He agreed needed to be a bit more aggressive. Did a third surgery with some grafting. Open procedure. Made changes, but I still feel as though I look deformed. This was all done in 1992-1993. Now I am 48. (notice assymetry, bulbous tip, and dent in the middle.) Want to find out if ever possible to fix.
(Questioner submitted photos)

Dr. Denenberg's answer: Meaningful improvement is likely in expert hands
Hi,
From the information available in the photos, it does seem as though you should be able to get more improvement in your nose. What I notice: the upper part of your nose, where it's made of bone, is still a little wide, making an irregularity on the frontal view; the tip is still wider than it needs to be; from the front, the tip seems to droop down between your nostrils more than average; from the profile, the tip can still be elevated a little.
These are all changes that should be possible, even in a multiple revision. The problems relate to the size and position of bone and cartilage, and changing those elements of the nasal anatomy is very possible in revision surgery.

Link to this question on RealSelf.com


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