Hi Dr. Naderi, I had a primary rhinoplasty a few months ago. Recently, I noticed that when I run my finger over my bridge, I can feel my septum in the middle and two side walls on each side. I also feel small spaces between the septum and side walls. Is this normal after a hump is removed? I asked my doctor, and he said that this is normal, and that by keeping the septum a bit higher than the sidewalls, the dorsal contour is more round than flat. However, I was always under the impression that the sidewalls are to be brought over the septum after hump removal. Can you please explain? Will I need a revision to bring the walls over the septum?
Good question. First of all its probably too early to judge. Wait till the one year point before deciding. The more important issue is “how the nose looks” and not “how the nose feels” after a rhinoplasty. Usually a nose that has never been operated will feel smoother than a nose after a nose job because the edges of bones and cartilages heal an fuse over time and slight palpable irregularities are not abnormal. Basically, if your nose looks good after a rhinoplasty but feels bumpy, you should think about leaving it alone. But, if as time goes on and the swelling resorbs, you can now see the irregularities which you are describing then a revision rhinoplasty may be needed. Also, your surgeon is wrong in his reasoning. One of the major issues with hump removal is an “inverted V deformity” and that is usually caused by the upper lateral cartilages retracting down from under the nasal bones and the dorsal septum so leaving the dorsal septum higher and allowing the upper lateral cartilages to fall down and not closely approximate each other and the dorsal septum makes no sense. That is one of the reasons for spreader grafts: to recreate the roof by attaching the upper lateral cartilages and the dorsal septum together. Take a look here for the illustration at the end of the page showing spreader grafts: http://www.rhinoplastyspecialistsurgeon.com/rhinoplasty-types-areas-virginia/crooked-twisted-nose/
Still too early though. Just wait and watch and see…