I am a female patient w/ thick skin who underwent an open revision rhinoplasty several years ago, and am overall happy. However a minor amount of pinching remains (see photos). I can hide this ok with make-up (4th photo - which shows what my nose would ideally look like all the time.) Do I have unreasonable expectations? Can this be treated via revision / fillers? Would a revision surgery for something like this be extremely expensive? Is the risk worth it for a nose I'm fairly happy with?
Another Revision Rhinoplasty: Worth the Risk?
Doctor Answers 7
Risk of multiple revision rhinoplasties
The risk to reward ration in performing a revision rhinoplasty is a difficult question to answer. The bottom line is that if the pinched nose appearance bothers the patient, then one should consider further revision rhinoplasty surgery. Look for a rhinoplasty expert who truly devotes their practice to the field of rhinoplasty. Spreader grafts are usually employed to widen a pinched in midthird and lower tip, and improve the airflow dynamics through the nose. This helps with the pinching significantly. A revision rhinoplasty costs anywhere from $7,000-$10,000 and includes the operating room, anesthesia, and the surgeon’s fee for performing the procedure.
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A revision could make your tip look smoother and less pinched
To my eye, it looks like your nose has lost some support along the alar margin and the sides walls of the tip. This creates some contour depressions on each side of the tip, leading to some shadows which bracket and isolate the tip. This could be corrected with structural cartilage grafting to replace the support that is deficient. I would advise against fillers in the lower aspect of the nose, particularly in a previously operated nose as complications such as skin necrosis can occur. Whether or not it is worth it for you to pursue depends on how much the problem bothers you weighed against the risk, recovery and expense (which varies a lot surgeon to surgeon). Best of luck.
Is another Revision Rhinoplasty work the risk?
I have performed Rhinoplasty and Revision Rhinoplasty for over 20 years and from your photos, it appears that your nasal tip cartilage has been over resected to the point it has very little remaining to create a symmetric, normal looking tip. However, as a female, it's not that aesthetically off for you to have a very small nasal tip and if a small amount of filler, like Perlane or Juvederm was placed in the nasal tip indents, this would even things out nicely.
IMHO, small onlay cartilage grafts (must be glued or sewn in place) would accomplish the same goal but carry the risk of residual swelling and scar formation that every Rhinoplasty (more so with revisions) carries. IMO, try the filler first and if you just can't continue doing that and you must have surgery...find a very skilled Revision Rhinoplasty surgeon that will do what I mentioned above and nothing else. Conservative, in your case, is better.
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Revision Rhinoplasty Surgery
It is possible to perform a revision rhinoplasty to widen the nasal tip and eliminate a "pinched" appearance. I would not recommend fillers in the nose, as I have seen many complications arise from their use. Whether or not you would like to have a revision performed is strictly a personal preference. Depending on your needs, a revision can range from $12,000-$20,000. Thank you, and best of luck to you.
Having another revision rhinoplasty for tip pinching
A revision surgery could be considered to treat the pinching you're seeing. Whether or not surgery is worth it depends a lot on how much it bothers you. Consulting with a revision rhinoplasty surgeon to discuss your concerns would allow you to get a better idea of whether the benefits out weight the risks.
To fully address the area I suspect cartilage grafting would need to be done. If you have enough septal cartilage to use, this may require the use of cartilage from either your ear or rib.
I personally don't recommend injecting fillers into the tip.
Based on your photos, you may be a good candidate for a Non-Surgical Rhinoplasty treatment.
I read your concerns and reviewed your photos:
You appear to have deep, asymmetrical creases above your nostrils, and your tip is a bit pinched and narrow. In my practice, you may benefit from a well-performed Injectable Filler treatment to restore symmetry and soften your tip. I prefer to use Silikon-1000, an off-label filler for permanent results.
In my practice, revision rhinoplasty is left as a last resort.
I hope this is helpful for you.
Regards from NJ.
This is an individual choice as to how much it bothers you. I do think you could have some grafting to the pinched areas through a closed approach which would give you some improvement without having a complete revision. I don't think fillers would help as the skin of the depression will likely not separate and lift.