Another common issue for which patients seek a revision rhinoplasty consultation is if the bridge is lowered too far during a previous rhinoplasty. Some patients describe these noses as looking scooped, like a “ski slope”. Lowering the bridge too far can cause the upper part of the nose to appear wide and may give the nose a less natural-appearing, “nosejob” look.
The decision of how far to lower the bridge in rhinoplasty is a very important one. It’s very important to consider the patient’s ethnicity, age, gender, tip position and overall aesthetic desires. Some patients prefer a slightly curved or convex bridge, others desire a straight bridge, and still others like a lower, softer, slightly concave bridge. Computer imaging during the consultation can help the surgeon and patient determine which bridge shape or height is most desirable and best suited for the patient’s other facial features.
If the bridge is lowered too far during previous rhinoplasty, there are a few options for raising it back up. The first is to use cartilage grafts called onlay grafts. These are thin pieces of cartilage are ideally taken from the septum and laid on top of the bridge to raise its height. If septal cartilage is insufficient or unavailable, ear or rib cartilage can be used. These grafts are carefully tailored and shaped to avoid prominent edges, which can show through if the patient has thin skin on the bridge. These grafts can also be made out of bone taken from the septum, though cartilage is easier to work with.
The second option is to use a piece of ear cartilage and dice it into hundreds of fine pieces, < 1 mm in size. This diced cartilage is wrapped in a thin tissue called fascia, which is harvested from the temporalis muscle. This is the large bite muscle that bulges in the temple while chewing. The fascia is taken out through a tiny incision (1-1.5 cm) behind the hairline and above the ear. The hair is not cut or shaved and the incision is very well hidden. This combination of fascia and cartilage is often called a “Turkish Delight”. This graft can be placed on the bridge to raise it, and can be a particularly good choice for patients with thin skin. An advantage of the Turkish Delight graft is that it can be molded by massaging it after surgery, to narrow, straighten or flatten it.
A third option is to place a synthetic nasal implant, such as Gore-Tex, Medpor, or silicone. In general, Dr. Mehta prefers to use the patient’s own cartilage to minimize the risk of infection, chronic irritation, or extrusion, in which the implant actually pushes out through the skin of the nose. For patients who lack sufficient septal cartilage but do not desire rib cartilage harvest, these implants could potentially be options.
A fourth option for patients with a low nasal bridge is the use of injectable fillers such as Restylane, Perlane, Juvederm, Radiesse, or Artefill. This is called the “nonsurgical rhinoplasty” and can be done in just a few minutes in the office. The choice of which filler to use is based on the desired longevity of the filler, the ability to dissolve or reverse the filler material, and whether the patient is considering a rhinoplasty in the future. Small indentations or asymmetry following previous rhinoplasty can be camouflaged with this nonsurgical procedure.
If you feel that your nasal bridge is too low, either naturally or due to previous surgery, please feel free to contact Dr. Mehta for a consultation. He will go over all of your surgical and nonsurgical options and perform computer imaging to help you determine the best course of action.
To book a consultation or for more information, please contact us.