Your question: Is This a Normal Result After Septorhinoplasty?
I got septorhinoplasty almost 5 months ago and i am depressed how my nose looks from the front and am so self concious now when i smile. I had deviated septum fixed, dorsal hump removed and deprojection of my nose done and NO TIP Work done. My nose looks great from the side profile but looks huge and like a shapeless potato from the front when i smile. Is it normal for it to look that way? Can steriod shots help? Please help thank you
Dr. Denenberg's answer: It's possible to improve the frontal view, depending on what was done to your tip cartilages
Hi. Forgive me if I try to address your frontal view by starting with your profile. When a hump is removed, it can make a nose look longer, so we often shorten the nose. Making the nose shorter can help the frontal view by presenting less of a vertical height of the nose. See my Web reference link for a morph I made of your profile view.
Since you had no tip work done, the tip of your nose probably didn't deproject, because deprojecting the tip of the nose, and shortening it, require complicated work on the tip. In my morph, I raised your tip and deprojected it.
Further, when a hump is removed, it's important to look at the very top of the nose, just below the eyebrows. If that part of the nose isn't reduced as well, the profile can take on a little bit of a Roman statue look, where the forehead seems to slide right onto the nose. You'll see in the morph animation that I brought that part of your nose closer to your face. If you find yourself thinking about a revision to get the frontal view looking better, you might think about these changes to the profile, too.
I personally don't think steroids would work very much this late after surgery. I would hope that at least part of the problem is due to the fact that no tip work was done, because that would make it more predictable to make some improvements we are better at modifying cartilage than controlling the thickness of skin or scar tissue under the skin.< p>
From Steven M. Denenberg, M.D.
Here is the modification I made of your profile. I brought the tip of your nose back closer to your face, raised the tip, and especially reduced the strength of your nose, at the top, just below your eyebrows:
Click on the photos above to see rhinoplasty patients of mine, many of whom had their noses shortened and deprojected.
Here is an animation of the morph:
Raising the tip of the nose and bringing it back closer to the face involve complicated work on the tip of the nose. You mentioned that tip work was not in the plan for your rhinoplasty, but in any event most plastic surgeons are not able to make these changes. If you have a revision, you need to see before and after photos of the doctor's other patients who had deprojection and elevation of the tip, so you can be sure he has the skill to accomplish those changes.
Let me know what you think of these modifications.
If you have any questions about this, or if you want me to evaluate any other photos of yours, feel free to email me:
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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; 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 do 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.
Thought experiment: you are going to hire a portrait painter to paint your portrait. Would you really hire the painter if he wouldn't show you any of his other portraits?! No, it would never occur to you to hire him. Well, now you're going to hire a surgeon to change your nose, in the middle of your face, and you aren't going to insist on seeing examples of his work, proof that he knows what he's doing? Think about it. Teach your friends.
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?
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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