Although it's difficult to provide a definitive answer based on photos alone, it does appear that there is an irregularity in the bone and cartilage of your dorsum. At 4 months you are still fairly early in your recovery so your nose will change in appearance, so your bridge may or may not improve. Revision rhinoplasty may be necessary to smooth the contour, but shouldn't be considered until the nose is fully healed.
Thank you for your question, and included images.
It appears that the transition between the upper lateral cartilages, and the lower lateral cartilages is more pronounced than I would like to see.
This is a particularly complex area, and the best measure of how significant this will be, is best determined after you fully heal. This may take several more months.
I agree with your surgeon's advice to massage and remain patient.
S.P. Maggi, MD, FACS
Austin Plastic Surgery Center
It is always difficult to speculate on something of this nature. There does appear to be swelling, which will mask the nature of what may develop.
Kenneth Hughes, MD
Los Angeles, CA
Without actually seeing the internal anatomy of the nose at this time- it is limited to determine an explanation. The nose is comprised of -- skin, bone and cartilage. The surgeon has control over the cartilage and bone under the skin. Therefore, it is imperative that the surgeon skillfully sculpt the bone and cartilage under the skin so that the skin can reflect this internal sculpting. Healing occurs at differing rates-- what you see could be just swelling. Time and massage will tell. If after a reasonable amount of time--- you are still concerned-- time to possibly have a revision.
There seems to be some asymmetry of the height of the cartilaginous dorsum versus the bony dorsum. There's also obvious swelling. This should be allowed to resolve before a revision but I do think a revision will be necessary.
This is uncommon and could represent several things....none of which you should attempt to treat at the present time in my opinion. Waiting until lees swelling and all is stable is best. Then options can be discussed. it may well be that fillers are a great option. Only time will tell.
It still very hard to tell what's going on in spite of the photos you supply. it almost looks like a pressure mark, from glasses, or a bandage. I suppose it could be the effect of a steroid injection if any was performed. Otherwise it might be just the underlying bone and cartilage showing through. Follow your surgeon's instructions and follow up visits until it becomes clear.