Septorhinoplasty has made my entire appearance worse - for reasons unclear

[UKMaxfac]

Forgive me for reposting this but I'm still struggling:

I had a septorhinoplasty with a UK based surgeon in 2015. The recovery was laborious, painful and far more difficult than I expected. The surgery took 3.5 hours and 12mm of septum was removed, with the vomer 'corrected' and the nose somewhat straightened (though still obviously not straight post-op).

I now have a significantly shorter middle and lower face since the surgery. Could this be due to the muscles surrounding where he made incisions? I'm clutching at straws here, I really dont know what to do.

In the few weeks following the surgery I felt absolutely terrible. The surgeon had made an incision in my gums (which is now covered over by raw scar tissue) and the roof of my mouth was in agony. For over a month post OP I couldn't smile and my lower face looked 'heavier'. The soft tissues around my entire midface and lower third looked fatter and less well-supported and they still do to this day, even though swelling has subsided.

He told me he made the incision in the mouth to 'lower the floor of the nose', and that he has done this in many patients without problems. But now post-operatively its very hard to get air into my nose. I have to 'pull' air in deliberately, and I sometimes realise that I cant breathe through my nose at all and have to hang my mouth open. When my mouth is closed I bite together hard, infact all of my facial muscles feel 'tight' and my teeth are sore often. My entire lower face looks shorter, and my facial harmony has been disrupted.

Any ideas on what has caused a shorter face from a septorhinoplasty? And no, I'm not imagining it. I can PM other pics if needs be.
Before:


After

[ditterbo]

Same experience here so far as the mid-face soft tissue seeming to lose support (and also appear to melt away in the infraorbital rim). Except I don't see the loss of mid-face support, if anything the after looks better than the before (cheek support) for some reason.  Do you also see a loss of cheek tissue in the area below your eyes, right where your cheeks kind of start? Harder to tell maybe head-on as that's more of a 3/4 profile thing.  Informal theories I've read about online include the muscle between your center nose and upper lip being cut, and/or the septum has a hole in it somewhere, and/or less nasal bone support indirectly reducing support elsewhere, and/or surgery in general can cause fat loss / trauma to the surrounding tissue, and/or lots of work to the nose - cartilage grafts, all the s**t you're bringing up with the roof of the mouth, etc. raises the general risk of the surrounding tissue getting beaten up.

I'm not sure I see a shorter face but I do see you've got a decent amount of alar rim retraction (same fate here).  Also look at the sides of your nose when you breathe in through it.  You may have nasal valve collapse like I do, in which case breathe right strips make a huge difference (until your probable revision).

[UKMaxfac]

Same experience here so far as the mid-face soft tissue seeming to lose support (and also appear to melt away in the infraorbital rim). Except I don't see the loss of mid-face support, if anything the after looks better than the before (cheek support) for some reason.  Do you also see a loss of cheek tissue in the area below your eyes, right where your cheeks kind of start? Harder to tell maybe head-on as that's more of a 3/4 profile thing.  Informal theories I've read about online include the muscle between your center nose and upper lip being cut, and/or the septum has a hole in it somewhere, and/or less nasal bone support indirectly reducing support elsewhere, and/or surgery in general can cause fat loss / trauma to the surrounding tissue, and/or lots of work to the nose - cartilage grafts, all the s**t you're bringing up with the roof of the mouth, etc. raises the general risk of the surrounding tissue getting beaten up.

I'm not sure I see a shorter face but I do see you've got a decent amount of alar rim retraction (same fate here).  Also look at the sides of your nose when you breathe in through it.  You may have nasal valve collapse like I do, in which case breathe right strips make a huge difference (until your probable revision).

Thank you so much for that. I've been desperately trying to figure out what's wrong.
It was a s**tty job, no doubt. I've asked 2 different surgeons what they would do and one said rebuild with conchal (ear) and one with rib... so I'm not sure which is more effective and less uncomfortable long term. I believe I have some nasal valve collapse as you said. Ironically I went to a relatively big name maxfac in the UK for this... so much for him living up to his reputation.

I saw an ENT who said the septum is intact but couldnt offer me any solutions.

No I didn't see a loss in cheek tissue, my face looks fatter and less lean if anything since the surgery. You saw the opposite?

[Lazlo]

i can see that your nostrils are overly retracted (i.e. pulled up) and that's a sign you have a deformity as a result of your rhinoplasty. You really should have that work revised as it looks much worse than your before nose (which honestly was perfect, it was a Michael Fassbender nose). You should have left the nose alone. But yeah you need your nostrils brought down and "spreader grafts" placed within them. Don't skimp on the revision rhino. Go to someone only known for revisions.

[UKMaxfac]

i can see that your nostrils are overly retracted (i.e. pulled up) and that's a sign you have a deformity as a result of your rhinoplasty. You really should have that work revised as it looks much worse than your before nose (which honestly was perfect, it was a Michael Fassbender nose). You should have left the nose alone. But yeah you need your nostrils brought down and "spreader grafts" placed within them. Don't skimp on the revision rhino. Go to someone only known for revisions.

The nose before was extremely asymmetric from frontal view, now it isn't, but you're right, thats about the only thing that was better.
Alfaro is offering me revision rhino at the same time as bimax, because he says that way they can immediately start to correct any issues the bimax makes with the nose. I'm tempted because I save money this way.

It was not a michael fassbender nose. If it would have been I never wouldve gotten rhinoplasty.

[David_D]

It's difficult for me to compare the two photos since they're at a different angle.  In the before, it appears to me that the camera is angled downward to a greater degree than in the after photo.

[A-V-P]

I's so sorry for what you are going through.

I happened to read Realself couple of days ago. There was couple of Uk plastic surgeon Lucian Ion patients whose revision rhinoplasty journeys caught my eye. This one guy had like 7 rhinoplasties: https://www.realself.com/review/london-uk-33-year-male-revision-rhinoplasty-procedure#comment-5100542 and Ion finally was able to fix it. There is woman too whose nose was pretty messed up and Dr Ion fixed her nose too. She loves her new nose. Maybe you can check him out and talk to him if you are based in UK...
(Btw, hope he is not the one who messed your nose.)

[JawKid7]

looks like Uk surgeons got the worst rep. Especially under the nhs never go for a rhinoplasty/septo.

[Bowie]

Prof S said UK surgeons are something like 15 years behind German and Swiss, from the state of our GPs, I can believe it.

[Bowie]

this was Haers. Hes belgian and trained under Sailer, but works in the UK. Fwiw i've seen someone IRL he did jaw surgery on and she looked great, but rhino wise - a disaster for me

Oh well no surprise then, Sailer is s**t at rhinoplasties unless it's something basic.

[girl]

Some Swiss-based surgeons (Thuau) are also 15 years behind, maybe due to working in the UK and regressing.

Prof S said UK surgeons are something like 15 years behind German and Swiss, from the state of our GPs, I can believe it.

[kavan]

Forgive me for reposting this but I'm still struggling:

I had a septorhinoplasty with a UK based surgeon in 2015. The recovery was laborious, painful and far more difficult than I expected. .....I now have a significantly shorter middle and lower face since the surgery. Could this be due to the muscles surrounding where he made incisions? ...... The surgeon had made an incision in my gums (which is now covered over by raw scar tissue) and the roof of my mouth was in agony......He told me he made the incision in the mouth to 'lower the floor of the nose', ......My entire lower face looks shorter, and my facial harmony has been disrupted.

Any ideas on what has caused a shorter face from a septorhinoplasty? And no, I'm not imagining it. I can PM other pics if needs be.
Before:


After

An incision at the gum line, pain at roof of mouth, lowering the floor of the nose!!!

It looks like you're mystified as to what type of surgery you got and why you would see more changes to your face than just your nose. It also doesn't look like anyone pointed out how the type of surgery you got would differ vastly from what is usualy associated with 'rhinoplasty'.

The septorhino you got is also a type of maxfax surgery directed at a specific part of the maxilla; palate, roof of the mouth. (Incision at the gum line and pain at roof of mouth.)

Look at any ceph diagram where that part of the maxilla is marked out; ANS-PNS= Anterior nasal spine to posterior nasal spine. So basically, the FLOOR of your nose is the ROOF of the maxilla (palate).

They open the intermaxillary suture at the palate to lower the roof of the mouth which is basically the same thing as lowering the floor of the nose in that type of surgery aimed at straightening the septum.

Lowering the 'floor of nose' via an incision inside mouth at gumline= lowering the roof of the maxilla. That's the basic explanation as to why you would see more changes to your face than just a change to the nose. The soft tissue remodels subsequent to the manipulation to lower the roof of the maxilla.

[UKMaxfac]

Just look at my lips - it's so obvious. They are much more pushed together in the latter - it looks absurd like a duck

[ditterbo]

I'm ... not seeing it. I believe you but it's not apparent to me in that pic, even after you pointing out exactly what to look for.

[Lazlo]

An incision at the gum line, pain at roof of mouth, lowering the floor of the nose!!!

It looks like you're mystified as to what type of surgery you got and why you would see more changes to your face than just your nose. It also doesn't look like anyone pointed out how the type of surgery you got would differ vastly from what is usualy associated with 'rhinoplasty'.

The septorhino you got is also a type of maxfax surgery directed at a specific part of the maxilla; palate, roof of the mouth. (Incision at the gum line and pain at roof of mouth.)

Look at any ceph diagram where that part of the maxilla is marked out; ANS-PNS= Anterior nasal spine to posterior nasal spine. So basically, the FLOOR of your nose is the ROOF of the maxilla (palate).

They open the intermaxillary suture at the palate to lower the roof of the mouth which is basically the same thing as lowering the floor of the nose in that type of surgery aimed at straightening the septum.

Lowering the 'floor of nose' via an incision inside mouth at gumline= lowering the roof of the maxilla. That's the basic explanation as to why you would see more changes to your face than just a change to the nose. The soft tissue remodels subsequent to the manipulation to lower the roof of the maxilla.

^^^^ this dude nailed it. he's a pro.