Had open rhinoplasty on 12/16/11. Plan was to get hump removed, tip lifted with slight curve, & nose narrowed. I was expecting what I saw in computer imaging. After cast was removed, I noticed small hump which Doc insisted was "callus/scar tissue" because it was spongy-like & subsided when he pressed down on it. Now, almost 10 mnths postop; I'm not really satisfied with results. Nose still has slight hump that's bonelike & tip seems bulbous. (It's still swollen, i feel it) but i think it dropped
Honest Opinions, Thoughts, or Advice? Not Satisfied & I Have a Follow Up Soon. I'm Thinking Revision? (photo)
Doctor Answers (10)
Straight nose vs slight curve
When you look at your preop photos you had a dramatic improvement. It seems that you didn't just want the hump to go away but also get a small curve. The tip can take up to one year to show the final result. If you are no happy then you can go for a revision rhinoplasty at one year after surgery. If there is only a minor issue it can be addressed as early as 3months after surgery but for what you are asking definitely wait for one full year.
Disclaimer: This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.
Timing of Nasal Revision
Hopefully all opinions on this site have been honest. Discuss your concerns with your surgeon but I would not do any revisions until the swelling has resolved.
Thank you for sending the photos.
I am very sorry you are not completely satisfied with your result.
In my practice, if a patient is not satisfied, I have no issues with doing a revision, as long as it is within reason.
I would suggest giving it a full 12 months before making any decisions.
You need to make sure you have expressed your concerns to your Doc along the way, so you can work through this together. I would be very upset if a patient of mine was unhappy and they did not express true feelings about what was going on.
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Dissatisfaction with the results after rhinoplast require carefully defining the specifics that are problems to the surgeon.
Dissatisfaction after surgery certainly is part of our profession. Many times, allowing the healing process to complete itself will solve the problem. Other times, intervention or revision is needed. It is very helpful when the patient can precisely state what is the problems
If you are not satisfied, you should see your surgeon to voice your concerns
I know that we like to hear from our own patients if they are unhappy so that we have a chance to fix it
Start there and if you are still unhappy, then seek out a second opinion
Computer video imaging is a goal, not a guarantee of a specific post-operative appearance!
Thanks for including photos; they really allow much more acccuracy in our answers, even though direct physical examination is always best!
I'm sorry to hear of your dissatisfaction; although your result is a nice improvement and a masculine appearnace, it is clearly NOT what you wanted. BTW, I probably would have not created quite so much of a "scoop" or curved profile in my computer image--a man's nose is usually more straight, but with more tip projection as you requested, and as Dr. Schlesinger has noted. And I agree with his recommendation for a small (extended anatomic) silicone elastomer chin implant to harmonize your facial profile, though I prefer a submental incision to minimize the risk of implant infection. Both incisions work well.
Clearly, at 10 months most of your healing is complete, at least in terms of appearance, though there can indeed be more softening, sensation return, and slight decrease in swelling. Your bulbous tip may be more a function of skin thickness rather than plastic surgical manipulation, but this is one reason to wait for at least a full year to allow tissues to soften and scars to settle before adding more surgery (scarring) in an attempt for additional refinement.
Revision rhinoplasty is probably in the cards for you to reduce the dorsum (more), graft the tip, and refine (if possible) the bulbous tip framework (and chin implant, if you choose). If you feel your surgeon can achieve that for you, then revision by your original rhinoplasty surgeon will certainly be the most cost-effective. But if you feel unsure in any way, trust me, a third rhinoplasty is exponentially more hard than an already-harder secondary rhinoplasty. Seek one or more additional opinions with ABPS-certified plastic surgeons with extensive experience in rhinoplasty.
BTW, I do not think revision rhinoplasty is something best done under local as a "minor" clinic procedure. Though this is possible, I have done rhinoplasty both ways (local with sedation, and full TIVA general anesthetic), and feel I do my best work with the latter. Trying to keep the patient comfortable with vital signs stable (to save money or avoid the hassle of going to the hospital or surgicenter) while doing your best precision work is not easy. But then again, I operate at my own on-site AAAASF-accredited surgical facility with full anesthesia capabilities, so that I CAN do my best work.
Good luck and best wishes! Dr. Tholen
My Rhinoplasty Does Not Look Like My Pre-Op Computer Imaging - Why?
Thank you very much for your photographs and questions. This proves what I have always said - that you can do a better surgery on a computer in a pre-op exam room than you can in a surgical suite.
That being said, at 10 months, you pretty much have the nose you are going to have. Your slight hump is no longer apparent and may just have been swelling, but your desire for tip projection and definition needs addressing. I believe you wanted a profileplasty, and to get this, you need tip projection. One way to do that is to take cartilage from your ear or nasal septum and place on the tip of your nose to elevate it above the bridge.
Although you never mentioned this in your comments, if you were my patient, I would recommend a chin implant since your chin is retrusive and your lower lip hangs down. Both of these can be easily corrected by a intraoral silicone chin implant. This would balance your nose, giving you a more aesthetic, masculine profile.
Soon you will know
Rhinoplasty does indeed take up to 12 months to heal completely but the nasal bridge (or dorsum) tends to heal faster. So since you are close to a year it is likely that the small bump you still have is unlikely to completely resolve. This is no fault of the surgeon as this can happen in up to 5% of patients. What's important is that your surgeon adress the issue for you. Most often this can be taken care of with a small in-clinic procedure using only local anesthesia. Don't despair - this is easily remedied
Unhappy with primary nasal surgery
It is always hard to know what is possible after a rhinopasty , and the final result may still be months away for you. Be patient and understand that as long as the nose has any soft and spongy feel to it more healing may still be expected.. I professionally don't rely on computer imaging in trying to show what an anticipated result may be, because it is rarely accurate. My advice is to forget what you saw for a result and wait longer to see what you will get. If a secondary revision may be of benefit to you, I am sure your local Plastic Surgeon would be glad to discuss this with you.
Frank Rieger M.D. Tampa Plastic Surgeon
Rhinoplasty surgery is one of the procedures that takes the longest to fully heal and see the final result. Also, results that are predicted by computer imaging are only estimates and can never be guaranteed. If you notice that the tip is still firm and the dorsum still "spongy", then there is a chance more change will occur and you should be patient and not judge these results to be final. I tell my patients that they need to wait at least a year or more before determining the need for a revision. Keep in mind that if you raise your tip too much, it will create a "feminine" appearance that will not fit your face. Discuss these issues with your surgeon.
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.