Your question: Will cartilage be needed to fix my previous Rhinoplasty or deprojection the tip and reducing the hanging collumella work?
Ive decided to have revision rhinoplasty, but now the challenge is finding the best dr for my revision. 1 surgeon said he could bring my nose closer to my face by deprojecting the tip. Another doctor said cartilage is needed to fix my nose. I have hopes that it will be feminine and pretty. I feel like its still way to far off my face and overdone. Any advise would be a great help. I'm so confused .

Dr. Denenberg's answer: A caution for your consultations.
First of all, you are looking at having a reduction rhinoplasty, where the nose is made smaller. Generally, that means that it's unlikely that you'd need any kind of significant cartilage graft. In some of the views, it appears that too much was taken off of the bridge of your nose, leaving it scooped, but that is emphatically not the case your bridge looks low because your tip is over-projected. A cartilage graft, if placed on the bridge, would just give you a huge nose.
Here's the caution you want a nose that is feminine, and you feel it's way too far off your face, and I agree, and that means that you need a large, non-subtle change in your nose. Make certain that your surgeon shows you a computer modification, showing what he intends to do, that gives a large enough change, and make sure he tells you he can accomplish that change. The last thing you need is another operation, giving you a disappointing amount of change, and then you're looking at a third procedure.
See the Web reference link, below, for a morph I made of a couple of your images. I elevated the tip of your nose significantly that's a feminine feature , brought it back towards your face, and narrowed the bridge. Are those the changes you are looking for?
You should understand that making these changes requires advanced techniques that most plastic surgeons would not be able to handle. You must see your surgeon's revision before and after photos, to see whether he has been able to accomplish for others, what you want for yourself

 

1) Proposed before and after:

Here's an animation of those changes. Give it a couple seconds to load:

Other view:

And the animation:

2) Click here to see more revision rhinoplasty before and afters.

 

 

Click here to see most of the morphs that Dr. Denenberg prepared for other RealSelf participants!

 

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Plain talk about picking a plastic surgeon for your first-time or revision rhinoplasty.

I do lots and lots of revision rhinoplasties, and I'll try to give you some advice here, to maximize the chances that you'll be happy after surgery, and to minimize the chances you'll need a revision.

Important!!  How to tell whether your consultation was acceptable:

Photos.  If a surgeon doesn't show you before and after photographs, scratch him off of your list. Period. No exceptions. Deal-breaker.

You pick a surgeon primarily from his before and after photos. Diplomas, board certifications, hospital affiliations, academic appointment, and even reputation tell you nothing: a surgeon is never tested for his skill, his artistic eye, the quality of his outcomes, or even whether he cares that his patients are happy.

You must see photos of other patients who had some features similar to your nose. For example, if your nose has a wide and drooping tip, don't accept profile-only photos of patients who had a hump carved down. You can't see the width of the tip on a profile photo.

Revision nose operations are much more difficult than first-time operations, so if you are consulting a surgeon about a revision operation, you must see photos of his revision patients.

If you see the surgeon's photos, but you don't love them, scratch him off your list. You want to use a surgeon whose work you like. Don't assume that he'll do great on you when he didn't do great on the other people.

Communication. If the doctor treats you disrespectfully, scratch him off your list. If he won't patiently listen to what you want for your nose, same thing. How will he know how to make you happy if he won't hear what you want for your nose?

If he conducts the consultation from behind his desk and doesn't examine your nose, deal-breaker. If it's the nurse and not the surgeon who conducts the consultation, run away fastest. All due respect to the nurse, she doesn't know what's possible and what isn't. If the plan is to see the surgeon for the first time on the morning of surgery, deal-breaker. For sure.

Computer morphing. If the surgeon doesn't do computer morphing of your nose, scratch him off your list. The morphing is crucial, so the surgeon can prove to you that he understands exactly what your goals are. Also, if the surgeon recommends some changes that you hadn't thought of, you need to see the morphs, so you can see whether you like those changes.

Your intuition. If your gut tells you "no," don't use the surgeon. Don't ever use a surgeon only because you know him, or your kids know him, or he lives on your street, or your primary care doctor referred you to him, or he did your breasts, or your tonsils, or your wisdom teeth, or you saw his advertisement, or his awards.

I hear these stories all the time from my revision rhinoplasty patients. You must do your own evaluation of any surgeon you visit. And by "evaluation," again, we're talking mostly about seeing his photos and seeing how well he communicates with you. Don't bother checking the surgeon's licensure and board certification and hospital affiliations and all that; it'll just distract you from what's important.

Conclusion. The fact is, the great majority of plastic surgeons who perform rhinoplasty shouldn't be doing the operation. It's an incredibly difficult procedure, technically demanding, requiring experience, skill, judgment, an artistic eye, an exceptional level of communication and thoughtfulness, and a rare level of empathy and caring for the patient. No hospital board protects you by judging the quality of a surgeon's rhinoplasties and prohibiting him from operating if he's terrible. It's the wild, wild west out there, folks.

 

More plain talk: should you let your primary surgeon perform your revision?

Rhinoplasty is by far the most difficult of the facial plastic surgery operations. And revision rhinoplasty is ten times more difficult than a first-time operation.

First, you need to consider whether things didn't turn out great on your first operation 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.

Evaluate your surgeon again. Read the section above, on how to evaluate a surgeon for a rhinoplasty. If you saw lots of before and after photos of your surgeon's other patients 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. Even the very best surgeon has the occasional disappointing result.

However, if, on looking back, you decide that you did not do excellent research on your original surgeon -- perhaps you relied on a referral, or on his board certification, without being able to see his photos -- 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 then you'll be in the tough position of looking for a third operation.

 

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