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I recently had a devastating, overly aggressive, revisionrhinoplasty/sinus surgery which will require another revision. I have 3 questions for you....
My surgeon cut under my top lip to prevent my nose from pointing down when I smile. This totally changed my smile and how my lips come together (but he neglected to mention any potential changes to my smile could ever happen). My upper lip does not have the definition is once did and is much flatter. When I asked him afterwards if he cut the muscle under the lip, he said no, but that he "cut the footplate of the lower lateral cartilage and separated it from the scar tissue".
1. Can this be fixed in the revision surgery so that my old smile can be recovered and so that my upper lip will once again have the definition it used to?
3 weeks after the splint was removed, an extremely large indent (which almost reached the center point of my bridge) was glaringly obvious. A great deal of Restalyne was injected to fill in the indent, however, the bridge is missing a continuous "line" from the top of my bridge to my nostrils, leaving a crooked appearance (it's puffy where the filler is).
2. Will this ever fill in and heal completely or will cartilage need to be added during the revision surgery? 3. The skin was extremely thin where the filler was added (and it throbbed for 4 days). Will thicker skin generate over time or will I continue to have damaged thin skin where the filler was added?
thank you in advance for your honest feedback..........
In cosmetic surgery getting something "back to the way it was" is often not possible. While certain things may be adjustable, once certain changes are made, going back becomes a fruitless journey.
You said your surgery was "recent." Give things at least 6-12 months prior to deciding that you need another revision. The lip issues may even out. You have to realize that smiling is dynamic and when the nose droops down with smiling it means that the nose and the lips and the smile are connected and disconnecting this "connection" will change all of the components. Again give it time.
Your nose will change no doubt over the next few months to years and only then can you say for sure if you need cartilage grafts to fill in the bridge and create nicer brow-tip-aesthetic lines. I cannot comment on this without seeing you.
Skin can and will change during rhinoplasty but more so if the dissection was done in the wrong depth damaging the actual skin. I can tell you that usually when I have to do a minor touch up of one of my own previous rhinoplasties, I can get back into the nose very easily and entounter minimal scar tissue but some times when I do a revision of other surgeons' I encounter very heavy rock hard scar tissue and skin changes that take 30-40 minutes simply to enter the nose. This problem is encountered due to the previous surgeon lifting the skin in the wrong depth and damaging the muscle layer and subcutaneous layer of the nose skin rather than elevating the skin right on top of the cartilage and bone.
Give it time but you may require a fascia graft or Alloderm if the skin is very thin there.
Thanks very much Dr. Naderi. I also want to let you know that a thick piece of scar tissue was placed between my upper lip and the bottom of the tip of my nose to try to help the tip move upward. The piece of scar tissue (the surgeon said he double reinforced it--ugh) is very annoying and although it no longer hurts (it's been 2 months since the surgery), it has created a visible ridge above my lip (and has barely made a difference in helping my nose not point down when I smile). Will this ridge go away in time?
Most importantly---Can I get the piece of scar tissue removed during a revision surgery without causing a lot of damage to the area above my lip? I assume I get grafts to help my nose point upward when I smile.
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