Bad Rhinoplasty Help (Bossae) What Needs to Be Done to Fix It?

I had a rhinoplasty last year. It looks horrible and is sore. I have bumps on my tip that I assume to be bossae. One side has a bigger bump and looks like part of my nose is unattached and sticking up. On that side the columnella is also hanging down lower and looks like the cartilage is protruding. The profile looks apst normal from one side but weird from the other. The plastic surgeon had agreed to fix it but he just keeps saying something about "a soft padding." How should this be fixed?

Doctor Answers (9)

Revision Rhinoplasty

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Revision rhinoplasty can be very challenging. Prior to reoperating on a nose, it is important to allow for the swelling to resolve (takes at least 6mths), and for the surgeon to know what was done previously. If you are confident in your surgeon, I would have him preform the revision, because they know best what was done before. If you would prefer a second opinion, I would advise you seek out a plastic surgeon who is experienced in revisional rhinoplasty surgery. Good Luck


Los Angeles Plastic Surgeon
5.0 out of 5 stars 16 reviews

Bad Rhinoplasty Help (Bossae) What Needs to Be Done to Fix It?

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Photos, of your nose, would help in the evaluation.  If significant nasal tip asymmetry exists at 1 year after a Rhinoplasty, an open Tip plasty would most likely be required

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Revision rhinoplasty can help bossae.

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Hello;

If it has been one year since you have had  rhinoplasty and your nose is “sore,” you need a very thorough examination. 

I think your plastic surgeon should reevaluate it and then go for a second opinion.  I do not understand why your nose would be sore this long after surgery.  I understand why you may be unhappy with it, but remember that soreness generally implies that things are not quite right, and before any consideration can be given to revision rhinoplasty, you need to make sure everything is in order.

Generally, the tip bossae can be corrected entirely through internal incisions.  If the columella is hanging down on one side more than the other, it may be because there is some deviation of the septum.  That is not unusual, because the septum often forces some distortion of the columella. 

I think you need to have a game plan at this point.  You need more specific information from your surgeon.  I do not know what a “soft padding” means.  He may be thinking of putting in some mesh or other filling material to camouflage or disguise the bossae, but from what you write, I just do not have enough information.

My best suggestion would be have a consultation or second opinion with a very experienced nasal surgery super-specialist who has undoubtedly seen many rhinoplasty patients in need of revision rhinoplasty and hopefully can offer you a reasonable solution to the problem.

Robert Kotler, MD, FACS
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 52 reviews

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What needs to be done?

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It's difficult to comment without a photo. It sounds like you will need a revision procedure to reshape, support and line your tip against skin contracture. You need to see a surgeon with revision experience.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Tip bossa

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Without pictures it is very difficult to suggest what could benefit you.  Sometimes tip sutures or even grafts can improve the appearance.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

In select patients, the appearance of bossae may be improved by a Non-Surgical Rhinoplasty treatment.

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I read your concerns. You may wish to post a photo in a subsequent question for the RealSelf community of experts to review.

You may need a revision rhinoplasty, and if this is the case, it may be helpful to get a second opinion from a reputable, experienced rhinoplasty specialist.

In certain cases of nasal bossae, I have had good success camouflaging their appearance with Silikon-1000, an off-label filler for permanent results.

I hope this is helpful.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 270 reviews

Tip Bossa

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You describe a tip that  will need to be revised to improve your appearance - a picture would be helpful. It sounds like you're questioning your surgeon's advice; a second opinion may be beneficial and reassuring before you make a decision.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Seek a second opinion

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It is impossible to say exactly what your options are without seeing photos.  It sounds like you will ultimately require a revision rhinoplasty.  I would recommend you seek a second opinion from a surgeon who specializes in rhinoplasty.  Warmest regards.

Dr. Pippin

Gregory Pippin, MD
Metairie Facial Plastic Surgeon
4.0 out of 5 stars 6 reviews

Correcting tip bossae

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From your description, it sounds as if you may have tip bossae. The fixes can be numerous and include going back in and softening the areas you have had operated on or reconstructing the native cartilages, for example. If your columella is also hanging down, then simply putting a morselized softening graft may not be sufficient. I would discuss all of your concerns with your surgeon. There are other options as well but it would depend upon what was done previously and the overall position of your tip and columellar angle, etc.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.