Too Much Curve Post Rhinoplasty

6 Month Post Op Rhinoplasty-Still Waiting to Hear from my Surgeon, but Expert Opinions Would Be Really Appreciated, Many Thanks. The results of my op are affecting me really badly.I feel embarrased and am losing my self confidence.My bridge was quite straight before with a small hump(that didn't bother me much). I felt quite attractive apart from the tip (large and bulbous/boxy - this really bothered me ONLY from the oblique angle though).Now I feel the bridge is too low/curved, there is strange swelling along the bridge & under the nostrils?? The appearance is generally not good at all and I'm very worried.Please help!

Doctor Answers (19)

Revisional Rhinoplasty Will Require Cartilage Grafts

+3

It is clear based on your photos that you have had too much cartilage removed and/or there has not been adequate cartilage support placed during the procedure. This has resulted in an inward sloped dorsum and an over-rotated tip which, while acceptable to some patients, is not acceptable to you. Since you are six months after surgery, this result is not going to improve and secondary revisional rhinoplasty must now be entertained. This is going to require an open rhinoplasty with cartilage grafts. 


Indianapolis Plastic Surgeon
5.0 out of 5 stars 27 reviews

Too Much Curve Post Rhinoplasty

+3

This is typical of some closed rhinoplasty in which too much cartilage is removed without cartilage grafts for support with subsequent alar retraction after a year or so causing columellar show. Fortunately, an experience revision rhinoplasty surgeon can correct these problems. Make sure you see several before and after revision pictures before committing to surgery.

Mohsen Tavoussi, MD, DO
Huntington Beach Facial Plastic Surgeon
4.5 out of 5 stars 9 reviews

Scooped out nose after rhinoplasty

+3

I agree that there are a few aspects of your nose that could be improved with a revision rhinoplasty procedure. It's hard to comment on what has changed since surgery without knowing what your nose looked like before surgery.

There is quite a bit of pinching to the tip of the nose along with some asymmetry. There also appears to be retraction of your ala (causing more of your columella to be visible from the profile view). The nasal tip seems to be somewhat over-rotated (presumably a result of surgery, though it can occur naturally).

It sounds like your bridge was taken down more than you were wanting. Discuss with your potential revision rhinoplasty surgeon what your preferences are for the height of the bridge. Addressing the tip position may help quite a bit with the profile line.

I would also wait at least a year after surgery before having a revision. You could certainly discuss your problems with other surgeons in the meantime, but your nose will continue to evolve in the interim. Be sure that your surgeon has experience with revision cases and check out before and after photos to make sure you like the results.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

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Aesthetics and tip support

+2

No one can judge whether your bridge is too low but you. Some patients would be happy with your height--it is not distorted.  But if it looks too low to you, you can have a careful cartilage graft placed someday.

Your tip cartilages have been reduced to narrow your tip--a standard rhinoplasty step.  When cartilages are strong like yours, they have significant built-in internal stresses, and often cannot keep their shape if their dimensions have been altered too much.  That is why the sides of the tip have become bumpy and why your nostrils are now higher--the remaining cartilage cannot brace them in their preoperative positions.

 

This is all correctable someday.  Wait for the healing to finish and the tissues to soften and then find a surgeon experienced in treating problems like yours.  Open or closed technique doesn't matter: biology is biology.  Just make sure that you see results in patients with similar problems that you like,and that you trust the surgeon.

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon
5.0 out of 5 stars 20 reviews

Too Much Curve Post Rhinoplasty

+2

In my opinion, you have a bit too much rotation and projection.  On profile this accentuates a slightly over-reduced bridge.  It might be possible to relieve some of the tension on the tip and make the bridge look relatively stronger. It is hard to tell by the pictures, but it looks like you might have a too-prominent tip graft that could be reshaped or removed.  I would actually still wait at least a year in case other issues become apparent that might need to be addressed with the revision.  One other opinion - PLEASE be careful have anything injected into you nose, especially something permanent.  Removing injectable silicone, for example would be extremely difficult or impossible to do if you didn't like the result. 

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Rhinoplasty revision

+2

Honestly, the amount of slope is a matter of preference. And without knowing what was discussed prior to the procedure I don't think it's fair to say whether the result is good or bad. It really depends on what the goal of the procedure was. I do see some issues with the tip and the columella and if these things bother you as well as your slope I would discuss this with your surgeon. But these types of things can always be improved with a revision if you go to someone with experience in revision rhinoplasty.

David E. Kim, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 47 reviews

You may be a candidate for a Non-Surgical Rhinoplasty to raise the height of your bridge after previous surgery. Video attached.

+2

I read your concern and reviewed your photos. Your bridge has a gentle feminine curve that looks acceptable. If you would like your bridge raised to provide a straighter appearance, you may benefit from a well-performed Injectable Filler treatment. In my practice, we could try a non-surgical approach for reducing excessive nostril-show and improving minor tip irregularities. My personal preference is to use Silikon-1000, an off-label filler for permanent results. In my view, you should leave revision rhinoplasty as a last resort.

I've attached a link to some photos here on my RealSelf page demonstrating Non-Surgical Rhinoplasty after Rhinoplasty Surgery.

I hope this is helpful for you.

Regards from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 278 reviews

Too Much Curve Post Rhinoplasty

+2

your nasal tip is still boxy with asymmetrical nostrils and foreshortened nose.

This can all be addressed  with a revisional surgery.

Erel Laufer, MD
Tampa Plastic Surgeon
4.5 out of 5 stars 14 reviews

Too Much Curve Post Rhinoplasty

+2

The photos tell it al. What might be a great result to someone is an unacceptable to another. Best for you to see a few in person surgeons to describe your issues in detail. I might try a filler to slightly increase the bridge and sides. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

Rhinoplasty regrets

+2

The difficulty in rhinoplasty in is understanding patient goals or expectations, and in all of cosmetic surgery, an appreciation of aesthetics or what looks right. Perhaps twenty years ago your result is very typical of a good result after rhinoplasty, upturned, slight scoop and projection of the tip above the bridge, tight thin tip. Aesthetic appreciation today has moved away from this ideal. To many, your result may look too much like a rhinoplasty, and not a more natural nose. Things can be adjusted though it will take a good bit of revision. Communication and photo simulation can improve understanding of expectations.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 29 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.