How Can My Upturned Short Nose From My Initital Rhinoplasty Be Fixed?

Q: Dr. Eppley, I had a rhinoplasty in 2010 and I feel that it looks short for my face, nostrils not the same shape or size, alar base too round and wide, nostrils are flared. Nose is upturned and too short for my face. I feel my upper lip has too much space from lip to nose. Would like a softer more feminine appearance.

A: Thank you for sharing your story and photos. I obviously do not know what your nose looked like to start with and exactly what was done to your nose. It would be extremely helpful to see photos and the original operative record from your 2010 rhinoplasty. What types of grafts were harvested (if any), where they may have been placed, and what is left of the original cartilaginous structures will all play a part in what needs to be done. Secondary rhinoplasty surgery is usually much more difficult because of scar, distorted structures and sometimes depletion of easily available cartilage graft harvests.

But that important issue aside, your nose is short with wide nostrils. The tip lacks projection, the columella is short and upturned and the dorsum is low. Such a nasal shape is very characteristic of many ethnic rhinoplasties. (as said by a Caucasian plastic surgeon) In changing your nose to your desired goals, it is a matter of the degree of change. It is an issue of either tip derotation and nostril narrowing or that combined with dorsal augmentation. That aesthetic difference is important as that would determine the type and amount of cartilage grafting that will be needed. But either way cartilage grafts would be needed and most likely that means costal or rib graft harvesting to get the amount of straight pieces of graft needed, particularly if dorsal augmentation is going to be done.

As for the lip lift, I don’t see the benefit in your case. Your upper lip skin is already at a good length with substantial upper lip vermilion show. I think you perceive your upper lips as short, as least partly because of your short and up turned nose. While I doubt its benefits to you, I would at least wait until the nose is done and see what you think about your lip then. An open rhinoplasty and lip lift has to be performed separately anyway due to blood supply concerns of the intervening columellar skin.

Dr. Barry Eppley

Indianapolis,Indiana