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Revision Rhinoplasty for Tip Refinement 4 Months After Initial Surgery?
asked 3 years ago by cupcakeceri in london
Latest answer by David Alessi, MD
Question viewed 15,818 times
Tags: nose tip, female, 4 months post-op, swelling
I had a closed Rhinoplasty nearly 4 months ago. I have noticed that the swelling has gone from the bridge, but the tip doesnt seem to have gone down as much. I feel that the tip of my nose from the side now looks too big for the top part which has gone down, making my nose look unbalanced. By four months, I feel most of the swelling should have gone in the bridge and tip. Should i think about a revision?
38 answers to Revision Rhinoplasty for Tip Refinement 4 Months After Initial Surgery?
+2
Please Wait One Year before Revising Your Rhinoplasty
Hi Cupcakeceri,
You should wait for one year before considering revising rhinoplasty on the nasal tip. The tissues and the plane between them need that time to heal and soften.
Swelling following rhinoplasty takes time to resolve. Specifically, nasal tip is the last place for swelling resolution and absorption.
It may be difficult to wait but you will be best served to wait that time. It is possible that the swelling of the nasal tip will improve significantly enough that you...
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+1
Tip still appears swollen 4 months after Rhinoplasty
The nasal tip can still have some swelling at 4 months following a Rhinoplasty. You could ask your Rhinoplasty surgeon for kenalog injections or instruction on how to perform manual lymphatic drainage to remove this residual swelling...which is what I teach all my Rhinoplasty patients to di daily beginning at 1 month post op.
+1
Revision Rhinoplasty for Tip Swelling
Revision rhinoplasty should only be considered after one year since swelling and healing can still factor into the end result. However, I encourage you to explore kenalog/steroid injections to reduce the supratip swelling, commonly known as a pollybeak deformity.
+3
4 months is too early for tip Revision Rhinoplasty
You should definitely wait longer then 4 months before you consider revision rhinoplasty for the tip of your nose. I usually recommend a wait of at least a year but I have gone in earlier on rare occasions. Your surgeon should guide you appropriately if you are unhappy with your nose.
Jason B. Diamond, MD
Beverly Hills Facial Plastic Surgeon
Beverly Hills Facial Plastic Surgeon
+3
Rhinoplasty and Tip Swelling
You still have significant tip swelling four months after your rhinoplasty. I don't see a hanging columella, but there still is a little too much supra-tip and tip fullness. The "ideal" tip to nostril proportion is 1:2 and right now your nose appears to be closer to 1:1. As your swelling resolves your proportions will get better. After one year, you may need a small amount of the supra-tip dorsum removed if the 1:2 balance is still off.
Daniel Reichner, MD
Newport Beach Plastic Surgeon
Newport Beach Plastic Surgeon
+2
You should wait a year before revision rhinoplasty
I know it's frustrating 4 months after rhinoplasty to look in the mirror and see a round tip. This is normal healing. It takes at least a year or more for the final swelling to fully go down. It is important to allow all the healing to take place, not only to avoid what may be un-necessary revision surgery but allow all the scar tissue to soften and the cartilages to achieve their final contour.
I have had many patients who thought that they might need revisions to further narrow the...
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+2
Revision rhinoplasty after four months?
Absolutely not. The last place that swelling resolved is the tip. At four months, the tip is just starting to be defined, and will change dramatically over the ensuing nine months. Unless there is significant asymmetry, you should wait at least nine months to one year after surgery. Speak to your original surgeon express your concern and I am sure your surgeon will address your fears.
+2
Tip Revision 4 Months after Rhinoplasty
Final maturation with total resolution of tip swelling usually takes longer than 4 months. Your tip does appear relatively big at this time, but it is best to wait up to one year before revision surgery. Serial photographs and examinations will help in the timing of that operation. A young lady like yourself wants this to be the final and definitive procedure.
+2
Don't Revise Your Rhinoplasty Prematurely
Premature revision of a rhinoplasty is a bad idea. Even if it is obvious that a revision is necessary, you should wait for the healing to be mature. The surgeon should be looking at a stable nose when they start the operation and that is at least a year out. I have practiced for 10 years and can say I see changes for years after surgery.
I trained with a surgeon who had been in practice for 30 years. He had one year post-op rhinoplasty photos of women in their 20's and then new photos...
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+2
Tip swelling after rhinoplasty
Swelling after rhinoplasty can take several months (often 12+) to resolve, especially in the tip. This is especially true if the skin is thicker. Your tip wll likely continue to change over the next several months and up to 1-2 years.
Sam Most, MD
Bay Area Facial Plastic Surgeon
Bay Area Facial Plastic Surgeon
+2
It is best to wait before revision Rhinoplasty
Tip swelling is often the last area to resolve, especially if you had a wide or bulky tip to begin with. It can take up to 12 months for all residual swelling to go away in the tip. A rough rule of thumb is that if your tip still feels on the firm side, there is still swelling there. If it is still firm, gentle finger massage or the back side of an electric toothbrush can help. Most rhinoplasty surgeons will not consider a revision until 12 months from the original procedure.
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Farzad R Nahai, MD
Atlanta Plastic Surgeon
Atlanta Plastic Surgeon
+2
If the hanging columella is your concern, time will help but can be corrected
Hey Cupcakeceri,
It's often hard to sit on your hands and do nothing, but as you can tell from all the advice, most people would recommend being patient and letting things settle down. If we go beyond this early advice and think of what may be bothering you about the tip we notice 2 things.
First let's start by saying that overall your nose looks very good for this early stage. The two things we notice are:
You look like you have a slender face, and the tip at this point still looks a...
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Peyman Solieman, MD
Beverly Hills Facial Plastic Surgeon
Beverly Hills Facial Plastic Surgeon
+2
Wait for at least 1-2 years
The tip is the last area where swelling will resolve after a rhinoplasty. There are very few surgeons who would recommend considering any secondary surgery until a minimum of one year and preferably two years have passed. Unless these is a very obvious deformity that must be corrected, it is best to give the healing process substantial time.
Additionally, the nature of your tip skin plays a role in the rate of recovery and it does appear that your tip skin might be a bit thick. This means...
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+2
Give it Time, and Avoid the See-Saw
At four months post-op, there is likely to still be some tip swelling after Rhinoplasty. Because this is the most dependent (lowest) part of the nose, it takes longer for the lymphatic drainage of the nasal tip to return to normal.
Most surgeons would advise you to wait a full year before considering a revision, unless there is an obvious problem that is unlikely to resolve spontaneously with the passage of time.
Also, further refinement or narrowing of the nasal tip may make you perceive...
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Athleo Louis Cambre, MD
Los Angeles Plastic Surgeon
Los Angeles Plastic Surgeon
+2
Time after a rhinoplasty
Rhinoplasty tip edema can be a persistent problem even 4 months after surgery. For patients that present to my San Francisco area office my recommendation usually involves waiting at least 8 - 12 months after primary rhinoplasty when the concern is edema or swelling in the tip.
Give it a few more months and then re-evaluate. In addition discuss your concerns with your treating surgeon.
I hope this helps.
Steven Williams, MD
+1
Revision Rhinoplasty
It is very early to consider a revision when you are only 4 months post op. Swelling is almost always persistent at the tip. I would not advise a revision until you are 11 months to 1 year post op. I would schedule an appointment with your surgeon at 9 months to address any issues you may have at that time. I am certain that he wants you to be very happy with your results.
David Alessi, MD
Beverly Hills Facial Plastic Surgeon
Beverly Hills Facial Plastic Surgeon
+1
Swelling In The Tip After A Rhinoplasty Will Continue to Improve Over 1 Year
A rhinoplasty operation takes patience for both the patient and the surgeon after the surgery due to the time it takes for swelling to resolve. At 4 months after a closed rhinoplasty, it is normal to have swelling, especially in the tip. The tip is the last area of the nose where the it resolves. The swelling with continue to improve over one year. During that time, the tip of your nose will become less swollen and become more define.
There are...
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Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
Charlotte Facial Plastic Surgeon
+1
Revision Tip Plasty
AT four months following rhinoplasty surgery, there is still healing going on. There is usually tip swelling which may persist up as long as 12 months. Like all areas of the body, swelling occurs post trauma. Feel your tip. Does it feel full? I suspect so. That suggests that there is still edema post surgery which means that there is still healing going on. To decrease ankle swelling, ace wraps are applied and leg elevation recommended. You...
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Jonathan Berman, MD
Palm Beach Plastic Surgeon
Palm Beach Plastic Surgeon
+1
4 months is too soon for revision of the tip
Thank you for sharing your photo. Although, it is difficult to tell from the photos, the tip need to be felt. In general, 4 months is too soon to consider a revision of the tip. You need to wait 2 to 8 months before thining about anything like that. Meanwhile, discuss your expectations with your doctor.
I hope this information has been useful to you.
Jon I Sattler, MD, Board Certified Plastic Surgeon, Glendora, California
Jon Sattler, MD
Glendora Plastic Surgeon
Glendora Plastic Surgeon
+1
Tip issues 4 months after rhinoplasty
Four months is very early after a rhinoplasty. The tip is the last area to de-swell, and the supratip area in particular can linger in swelling for 12-18 months after surgery. The reason it takes so long for swelling to decrease is because the scar maturation phase of healing takes that long. Steroid shots can be beneficial to reduce your swelling faster. See your surgeon to express your concerns. If the issues persist at 12 months, then...
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Thomas T. Le, MD
Baltimore Facial Plastic Surgeon
Baltimore Facial Plastic Surgeon
+1
Timing for a Revision Rhinoplasty
One of the many key elements in revision rhinoplasties is that you have to wait at least 12-15 months after the primary rhinoplasty to allow for normal wound healing and to see the true secondary deformity. One needs to see what the final result will be from the deformity and to allow for normal wound healing. If one operates much earlier then scar begets scar and you have a further exaggerated poor result. I have seen this time and time again as I do a significant number of secondary...
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+1
Revision Rhinoplaasty at 4 Months? Not a Good Idea
Patience pays in Rhinoplasty. It is totally normal to have tip swelling 4 months after your procedure. As you may read elsewhere on this forum on from other opinions on this topic, the final Rhinoplasty result takes a year and sometimes longer to develop. Returning to the OR at this time would only complicate your healing and lead to more prolonged swelling.
+1
4 Months is Too Soon
Generally, 4 months is much too soon for evaluating the size of the tip of your nose.
Swelling can take 18 months to dissipate from the tip of your nose after rhinoplasty.
As you continue to heal, ongoing evaluation and discussion with your surgeon is the best course to determine if and when a revision might be appropriate.
+1
Revision Rhinoplasty for Tip Refinement 4 Months After Initial Surgery?
Persistent tip swelling after a revision is not uncommon. It may take months to years. Ask your surgeon if you are an appropriate candidate for cortisone injections (e.g. Kenalog) which may help hasten the process.
+1
You do not need a revision!
The tip is one of those structures that takes the longest to heal. The dorsum will come down rather quickly with respect to swelling. However, the tip can hold on to swelling for 6-9 months. Just give it some time before you make any decisions. You will be surprised to find out how much your swelling will go down in a few months. I would not contemplate revision surgery till 9-10 months following primary surgery!
+1
Revision tip rhinoplasty
Revision of the tip of the nose should be delayed a minimum of one year to allow for all of the swelling to subside; it can take that long and sometimes longer. Sometimes kenalog shots may be necessary especially in thicker skinned individuals in order to further reduce swelling especially if it affect the final tip shape and position. I hope this information helps.
Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
Jacksonville Facial Plastic Surgeon
+1
Consider kenalog injections
As stated by other surgeons tip swelling is not uncommon, especially with thicker skin. Injection of steroids (Kenalog) will help the final result and how soon you get there.
+1
Timing of additional nasal surgery
As the others have noted, there is clearly going to be swelling four months after surgery. And that swelling will be reflected in the lower parts of the nose, so the tip always lags behind the dorsum. During the healing process I will often use varying concentrations of an injectable steroid (kenalog), in order to selectively influence that swelling, and bring it down faster. That would be my suggestion for you at this point, and to delay any consideration of additional nasal surgery...
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+1
The more obvious the problem, the sooner you can revise
Although many surgeons use "one year" as a standard time frame before they would re-operate after rhinoplasty, I find this to be too rigid. If there is an obvious problem, even if swelling has not receded completely, then I think it is reasonable to go back in and fix the problem. However, judging from your photo, it does not look like there is an obvious problem. Swelling at the tip takes the longest to resolve and your nose will likely look more refined with more time....
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+1
Wait one year before considering revision rhinoplasty
Rhinoplasty is a complex procedure. The lymphatics, skin and soft tissue of the region lead to some normal post op swelling. This can manifest as minor tip abnormalities. At four months the healing process and remodeling of the tissues is still occurring. It is too early to consider any further surgery on the nose at this time. At a minimum, six months is usually needed to determine how the nose will look. Most experienced surgeons like to wait one year before considering any revision...
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Robert Mounsey, MD
Toronto Facial Plastic Surgeon
Toronto Facial Plastic Surgeon
+1
Revision Rhinoplasty: Knowing "If" and "When" Its Necessary
First and foremost, it is too early for you know whether or not you should consider revision rhinoplasty. The nose will undergo significant changes during the first SIX months after rhinoplasty, and usually takes a full TWELVE months for the final result to become apparent. As the swelling goes down, you may be more pleased with your results.
The general consensus among rhinoplasty specialists is that a patient wait for 12 months before proceeding with any revision. The reason for this is...
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+1
Agree with the above
Absolutely too soon to tell.
I do up to 150 noses a year and every single patients wonders if they are healed at 3-4 months.
Looking at photos over time I can assure them (and you) that you have at least 30% of your healing to go.
So, be patient and its likely you will have a great result.
Benjamin C. Marcus, MD
Madison Facial Plastic Surgeon
Madison Facial Plastic Surgeon
+1
Be patient after Rhinoplasty
Swelling in the tip can last several months. Furthermore, there is continuous healing after surgery on the tip. Consequently, we recommend waiting at least a year in order to accurately evaluate the results from surgery and determine if revision surgery is needed. At four months, you're still within that period and your best course is to be patient and follow up with your surgeon on a regular basis.
Corey S. Maas, MD
San Francisco Facial Plastic Surgeon
San Francisco Facial Plastic Surgeon
+1
Revision Rhinoplasty
Hi CupCakeCeri,
The swelling and fullness of the nasal tip takes time to settle. It appears that you are young and that your skin may be on the thicker, oilier side. In young patients it may take a year or even two for your nasal tip to settle, and for your skin to thin.
You should certainly wait for at least a year before considering a revision. If the "unbalance" between your tip and upper 2/3 of your nose is driving you crazy, then you may consider having a small amount of...
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+1
Wait for secondary rhinoplasty
Swelling after a rhinoplasty can last for up to and even longer than a year. Since you are only 4 months out from your rhinoplasty, I would wait. The tip may get smaller.
+1
Time is the best choice at this point
Four months is still early after a rhinoplasty. While it is a bit difficult to tell from your pictures, I think the skin of your nasal tip may be a bit thick and oily, and this type of skin takes a while to settle down after a rhinoplasty. On occasion, we can inject a small amount of steroid solution into the tip skin to help calm down some of the inflammation, but this is a discuss best had with your surgeon. Bt the worst thing you could do right now is rush back into the operating room--...
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Shahram Salemy, MD
Seattle Plastic Surgeon
Seattle Plastic Surgeon
+1
Be patient.
Most primary rhinoplasty patients will get to see the final result of their procedure after one year. Your nasal tip will be the last place to lose swelling especially if you had an open rhinoplasty. Go to your surgeon and have him teach you some tip taping techniques to help push the process a little. Taping your tip is akin to ACE wrapping a sprained ankle; it keeps the swelling down. I typically have my patients tape at night only to avoid social embarrassment. Good luck.
Dr. Shah
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Manish H. Shah, MD
Denver Plastic Surgeon
Denver Plastic Surgeon
+1
Time... and maybe a chin
Certainly a full six months at least need to elapse before considering any revisions. And the aesthetic cost of revisions also must be calculated. For example, further reduction of the tip may indeed reduce the size of the tip but can cause notching to the side of the tip, a "pinched look" that is a giveaway that surgery has been performed.
Your plastic surgeon can also discuss with you the role of the nose-chin relationship and how it affects perceived nasal size. As plastic...
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