2 Months Post-Op Rhinoplasty - Nose is Now Crooked and Longer Than Before

with hanging columella.My surgeon said its swelling and scar tissue because it's a revision,but x rays and new doctor showed hump on left bridge is bone.I realised he had done a poor job.I asked what procedure,if bones were broken,if he sutured tip,no answers. He said he only removed cartilage, but i feel something poking on the right side of tip, and on middle tip of left side. If i have cartilage removed (if he did add)will that distort my nose?

Doctor Answers (6)

Revision rhinoplasty considerations

+2

Hello Paola,

First of all, I absolutely agree with the other surgeons who have responded to your question, in that at 2 months after rhinoplasty, there is still a great deal of healing to go. Ideally, one would wait until around 12 months following prior nasal surgery before considering a revision rhinoplasty, though there are exceptions to this rule.

All that being said, there are a few issues that are identifiable in your photos. Obviously, a physical examination of your nose would provide the best opportunity to assess your nose fully. First of all, the bump along the left side of the nose gives me the impression that the left nasal bone has lateralized or moved to the side. At this point swelling over the entire nose is probably accentuating this particular issue but if it persists, that nasal bone can be refractured and pushed towards the middle of the nose.

Secondly, the "bumps" you are describing at the tip may be the result of changes in the shape of the tip cartilages, or lower lateral cartilages. Bumps visible in the nose, sometimes called bossae or knuckles, can be the result of underlying cartilage poking irregularly underneath the overlying skin. This could be the result of cartilage grafts or simply the way in which the underlying cartilage was reshaped. These are not very well visualized in the photos you uploaded but again, an in-person examination would be helpful. In some cases, these bossae can become more prominent as the swelling in the tip decreases. In other cases, the bumps may simply be swelling-related and may improve with time. 

The third issue I am noticing on your front-view is that the middle portion of your nose appears narrower than your nasal bones and nasal tip, what we call the inverted-V deformity. This can happen if the upper lateral cartilages fall towards the middle of the nose. If this persists, it can be corrected with placement of spreader grafts, which are long, thin pieces of cartilage taken from the septum to repair this internal valve of the nose. This technique may improve your ability to breathe as well and may therefore be covered by your insurance. 

My advice would be to address these issues with your primary surgeon but if you feel you would like a second opinion, seek the advice of a rhinoplasty specialist.

Best wishes,

Dr. Mehta


Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

2 months post-op

+1

even though you have some concerns about the early appearance of the nose it is better to wait before seeking a revision - 2 months is still very early in the course of healing.  The problems you see now may very well not get better with time (sometimes they will get worse)

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 130 reviews

Persistent bump and crooked nose after rhinoplasty

+1

You are still early i the healing phase so I would recommend waiting at least a year to see how your nose healsbefore considering a revision procedure. Asymmetric swelling can contribute to crookedness as the nose heals.

If the persistent bump you see is still present that can certainly be address as well. It's hard to comment on the tip bumps without an examination. Cartilage grafts are commonly used in rhinoplasty and are usually not palpable. The cartilage can be removed or revised if needed, though.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

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Nose Crooked and Longer Post-op

+1

You're only 2 months post-op - your nose will change over the next 6-9 months, hopefully for the better. Your pictures indicate you may need another revision. Select an experienced surgery who will show you multiple examples of his/her work. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
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Nose still crooked afer revision of rhinoplasty

+1

Nasal revision is more difficult than rhinoplasty the first time around, and it pays to select a surgeon carefully. If you nose is still crooked and appear longer than you did before, chances are it will not improve much over time. Unfortunately you must wait out full healing, and if the result is one you cannot live with find a surgeon with experience to see you through.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 26 reviews

2 months post rhinoplasty

+1

Dear Paolasf:

As you know, revision rhinoplasty will cause the swelling on your nose to resolve slower than if this was your first surgery. Because of the swelling a lot of the things that are present today may be gone in several months as the swelling resolves.

A hump from swelling, at this stage,  along the bridge should be able to be "pushed down" with your finger, and then the hump will return when you let go of your finger as the skin "fills up" with fluid again. As the swelling settles, in several months, the hump should disappear. However a hump from bone cannot be  ''compressed down'' at any point and probably will require more surgery.

From your pictures it appears that the left nasal bone is still too wide, but without a formal examination I cannot determine that. 

I recommend you find an experienced facial plastic surgeon, so you feel comfortable with your healing in the next several months and with the possibility of further surgery.

Best,

 

Michel Siegel, Houston TX

Michel Siegel, MD
Houston Facial Plastic Surgeon
4.5 out of 5 stars 69 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.