Having revised thousands of rhinoplasties, I have noticed certain features common to all.
Look for Proportion
Even a structurally symmetric, aesthetically pleasing nose can be a poor result if it is out of proportion with the other facial features by being too small or too large.
Clues to Bad Rhinoplasty
The real clues to a poor result are the asymmetries; malpositions, disproportions and decreased function that are seen.
For example, in the image below we can see collapse of the side walls and/or nostrils producing a “pinched look” or asymmetry between the two sides.
The bridge can be too low or too high, and the tip can be overly rotated or not rotated enough. There can be too much “nostril show” from aggressive cartilage resection causing upward migration of the nostril rims. Or too much nostril show from failure to raise the columella (area between the nostrils). Also, irregularities or distortions in the nasal tip can occur which can present technical challenges to the revision surgeon. There can be deflections or angulations of the tip or the entire nose.
As mentioned above, nostril asymmetries are particularly common with one nostril appearing higher or wider than its companion.
Worse Breathing
Finally, there can be a worsening of breathing , especially if a reductive rhinoplasty was performed. Making a nose smaller has to be accompanied, many times, by measures to assure that the airflow is not compromised. This means correcting any septal deviations and/or turbinate enlargement, as well as maintaining adequate openings through the nostrils and the areas above called the internal valves.
I’ve included photos of a nose showing most of these deformities with the subsequent post-operative results, after I corrected them below. Learn more about rhinoplasty here. If you would like me to take a look at your nose, you can contact me by filling out the online contact form.
