Septorhinoplasty

Hi Dr. Nassif,

I am 2 1/2 weeks post-op for 2nd septorhinoplasty by 2 new surgeons (recon and cosm (ENT)). The 1st surgeon had overresected the dorsum, took too much cartilage when shortening nose, caused an internal valve collapse on left side and an inverted v-deformity (or saddle nose). The tip of my nose was also assymetrical - right side higher than the left. After 1 year, I had no nasal support on left side of nose and could not breathe. These surgeons worked together to correct the deformity using grafts - ear cartilage and Alloderm. I could breathe perfectly after the operation (swelling?) - I can still breathe better than I could before as the swelling has gone down, but most of the swelling resided on the left side of my nose. Was this because most of the work was completed on the left side? Also, the bridge of my nose or the end of the nasal bones is very, very swollen still and right side of the tip swollen ( reduction?) it looks like the graft wasn't even placed on the right side of the nose and is still giving me that inverted v (shadow-type) look and asymmetrical with the right side raised higher than the left. The left side of my nose looks great aside from the bridge being swollen. The surgeon(s) and want to see me in 6 weeks to determine if they should give me collagen filler to stimulate the graft. Does this sound right to you? What about kenalog injections for the tip swelling? Should I use them? I have been crying a little bit. I am very scared that my nose will never be normal again. I am addicted to the mirror and driving myself insane with dissappointment. Is it too early to determine if this will actually look normal again after all of the swelling goes down? I am worried that the graft isn't visible and the Alloderm will undergro resorption. Did I make a mistake? The surgeons said we could work with it, but I am nervous about putting collagen in as it will not last, but he claims it will be permanent. Please share your thoughts.

[Paul S Nassif, MD]

Dear rockstar28,

I am sorry you are undergoing a lot of stress with your nose.  It is very difficult for me to help you answer many of these questions since you are fresh from surgery.  

I don’t use Alloderm, so I am not really familiar with that.  I do know there is a possibility of reabsorption.  I usually don’t recommend any type of injection in the nose with any type of fillers.  

However, you are very early from surgery and your nose has a great deal of healing to do.   My recommendation is that you visit your doctor so that you can get the appropriate answers and ask the doctor to please explain all of your options.  

I am sorry I couldn’t be of much help, but when it comes to immediate post operative questions, I really would rather have the doctor who performed the surgery answer these questions, since they understand your case.

Dr. Nassif

Paul Nassif, M.D.
Spalding Drive Cosmetic Surgery and Dermatology
Beverly Hills, California