Secondary rhinoplasty on an asymmetric over shortened nose
There are special patients for whom we want to fight in the operating room to improve their nose and breathing. This adorable patient had had 4 rhinoplasties before and suffered from an over-shortened asymmetric nose, but also breathing impairment related to too much cartilage trimming previously and badly broken bones. There’s also an inverted V between the top and bottom of the nose, humps and hollows, an asymmetrical retraction of the alae, and an asymmetrical tip.
I have since then greatly reduced the number of secondary rhinoplasties, reserving them only for patients who immediately accepted an imperfect result, but still improved, both aesthetically and functionally. This was the case after several hours of operation requiring the use of costal graft to lower and strengthen the nose, reconstruct cartilage defects and the use of piezo to reshape repeatedly broken bones. The result at 18 months shows a longer, more symmetrical nose, with fewer defects. There remains a somewhat strong aspect, some irregularities, and asymmetries that everyone accepts because it is better. Perfection almost never exists in rhinoplasty and even less in secondary rhinoplasty: you should not have surgery if you can't accept it.