Had open septorhinoplasty with osteoctomy last february to remove hump in nasal dorsum,improve breathing and fix droopy tip.First month could breathe ok,nasal dorsum was fuller and tip more refined.Now i think i have droopy tip,very flat dorsum which makes nose look more prominent(i have retrognathism).Supra tip takes definition from tip.Can't breathe(have to use nasal drops).Surgery had 0 cost,made at semi-public hospital.Should i trust the PS for revision?How can i address him about this?
Do I Have A Bad Nose Job and is a Revision Needed?
Doctor Answers 10
When a rhinoplasty revision is needed
The only firm time a revision is indicated is airway obstruction, the rest is very subjective influenced by personal tastes which as you read reviews will vary by surgeon or observer. Some would be delighted with your result. My observation is that the bridge (bony) was reduced a bit too much and a graft over the bridge will solve the appearance of a supra-tip. Steroids will be a mistake. Still however wait a year to decide.
Best of luck,
Although it is a little difficult to tell from your photos, it does look like you may have a small polybeak deformity. If your primary rhinoplasty was performed in February, 2011, then your surgeon may be able to improve the situation with a steroid injection placed into the area of supratip fullness. If the procedure occurred in 2010, then it is probably too late for a steroid injection to help. I would recommend visiting your surgeon to discuss in either case. Also you should definitely discuss the breathing issues you are having with him/her. If he/she is either unwilling or unable to address your issues to your satisfaction then you should seek out another surgeon who has a lot of experience in rhinoplasty. The type of surgeon you want is one who performs at least 100 rhinoplasty procedures per year. Good luck.
Concerns regarding rhinoplasty performed in the USA
You certainly have a reasonable rhinoplasty result. Its difficult to comment on the your situation without preoperative images. The mid third has either been slighly over resected or settled over time due to loss of support of the nasal septum. You have slight fullness in the supratip accentuated by the dip in the mid third. Finesse secondary surgery to deal with the breathing and persistent cosmetic concerns could be performed after a year of healing. A chin implant would be a good option to enhance and balance facial proportions.
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Consider Chin Implants
It is still too early to fairly judge a rhinoplasty performed four months ago. The tip may still have considerable swelling especially in a male with fairly thick skin and it may be up to year later before all that resolves. It would be helpful to the preoperative photos as well to be able to tell what is the result of surgery and swelling and what was naturally there. One thing that can confidently be stated is that the retrognathia or the illusion of the the weak chin was NOT caused by the rhinoplasty. This was likely overlooked in the preoperative assessment and is only noticable now because your paying more attention to it.
If you decide to have a nasal revision at a later time, placing a chin implant simultaneously would improve facial proportions and bring the nose and midface more in harmony with the lower face.
Wait another 6-8 months before considering a revision rhinoplasty. If you're not satisfied at that time and continue to have breathing problems, discuss a revision with your surgeon or get a second opinion.
Secondary rhinoplasty is risky, chin implant would look good.
Need to see preop. photos to make any fair judgment about the result, but certainly your present situation is not bad. You do have slight concavity to the dorsum and a small polybeak, but no rhinoplasty result is perfect. Redo surgery is risky and is a judgment call made by you and your surgeon. All rhinoplasty surgeons do them (about 15%), but the goal has to be very specific. Putting a graft in to augment the dorsum comes with a host of possible problems, partial resorption, irregularity, etc. You may wish you had settled for your present result. This may be a time to accept that your nose is not perfect but not bad either. You are a good candidate for a chin augmentation, which will be more helpful for your profile than secondary nose surgery.
If you cannot breathe through your nose, you do need to be assessed because this situation has health significance. Ask your surgeon about it or make an appointment for a second opinion.
You need to wait a bit longer. If after a year you are having an airway problem which is structural then you will need a revision. A revision for aesthetic reasons is a matter of taste. Some patients would love your result. some may prefer a little higher and stronger profile which would also reduce the illusion of supratip prominence.
I do not think that you have a polly beak deformity from your photo. It would have been nice to see pre surgical photos. Give the nose a year to heal before considering a revision.
Do I Have A Bad Nose Job and is a Revision Needed?
You will have to wait until at least 6-9 months after the surgery before considering a revision. You have over-resected mid-dorsum, high radix and a small poly beak deformity. A revision should address these problems as well as a chin implant in order to achieve a more balanced nose.
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