I have had rhinoplasty done 2 years ago.My main concern was the big tip of my nose, unfortunately that was not improved (believe nothing was done to it). After the surgery I could notice that the RHS of my nose is less define then the LHS one, which I didn't notice before although now looking at the old pictures I think that is how my nose was anyway and the surgery made it more obvious.Are there any chances to improve the shape of my nose and make my tip slimmer without it looking too overdone?
Would a Second Rhinoplasty Improve Shape of my Nose (Mainly Bulky Tip)? (photo)
Doctor Answers 11
Surgery for bulky tip
Thank you for your question and the photos. The photo do show a bigger tip. But, without in person examination it would be difficult to decided on the best approach for your tip. There are several question need to be answered; is the skin thick, do you have rosacea, what was done to cartilage in the first surgery etc.
My advice for you is to see a board certified plastic surgeon with experience in nasal surgery to determine the best approach for your nose.
Bulbous bulky tip
It looks like you have persistant bulbous tip as well as a pollybeak deformity when looking at the lateral view. This can be revised to remove the excess cartilage and scar tissue from your tip. As well, you would probably need a cartilage shield graft and strut. This will give you the definition in your tip that you are looking for. See links below.
Refinement Of The Tip in Revision Rhinoplasty
Thanks for the photos and question. Your nose can certainly be improved with a rhinoplasty focusing on the tip, also called a tip-plasty. In revision cases such as yours, in which tip work is required, I utilize an open approach to reshape the tip cartilages in a predictable, safe, and reliable manner. My philosophy when it comes to rhinoplasty is that the tip can be made smaller keeping the cartilages structurally sound, so that the scar contraction which occurs after rhinoplasty does not alter the shape of the tip over time. Over-resection of these tip cartilages can result in asymmetry, retraction of the nostrils, and pinching of the tip, all of which are problems I correct quite commonly in my revision rhinoplasty practice.
Your nose would likely require a combination of conservative thinning the tip cartilages (cephalic trim) and reshaping with techniques such as horizontal flattening sutures or dome binding sutures. Your septum also looks to be be overly prominent in the lower bridge, just above the tip. An in-person examination would be helpful to fully assess what's happening in your nose. I also find it useful to utilize computer imaging to help establish the aesthetic goals during the consultation.
The best advice I can give is that you seek consultations with a few surgeons who specialize in revision rhinoplasty and find one with whom you feel comfortable and whose "after" photos you like. In the hands of a revision rhinoplasty expert, your nose should not look overdone.
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Revision rhinoplasty to further decrease nasal tip volume and width and increase definition.
In reviewing your photos it would appear that at least some conservative surgery was performed in the nasal tip. Specifically, the volume was mildly reduced along the cephalic margins of the lateral crura. A revision surgery can be undertaken to further reduce volume and width as well as increase definition. This will likely require a combination of different maneuvers such as additional cephalic strip resection, domal suture techniques, tip grafts and possibly thinning of the sub-dermal layer of the skin cover. I do not feel that you have a typical postop 'polly beak' deformity as mentioned by another surgeon.
Mario J. Imola, MD, DDS, FRCSC.
Is a Revision Rhinoplasty needed?
Based on your requests, a revision rhinoplasty would be needed to achieve your goals.
Your tip is wide, amorphous, and lacks definition. I would do this under an open approach in order to correctly identify and treat the problem. Although a technically risky move, your nasal skin could also stand to be thinned to make the rest your nose's skin thickness. Cartilage tip modifications would also likely need to be done and extra cartilage can often be obtained from the bowl of the year, in the septum, and sometimes the rib.
mike kim, md
How to get a good revision rhinoplasty?
Your nose has a very thick skin, boxy, bulbous tip and wide nasal base which should be addressed in the revision. A small chin implant will improve your profile too. The most important thing you can do is to find a surgeon who is well versed with this type of noses and you can find one if you look at their before and after results. If you find a few similar to yours and like the results, then you will likely get a good result this time. Good luck
Revision of Nasal Tip and Correction of Asymmetry
Your are correct when you say that your tip is large, poorly defined, and out of proportion with the rest of your nose. This, as well as the asymmetry, can be improved with a revision. Admittedly I am biased because 2/3rds of the rhinoplasty surgery I do are revisions but you should have significant improvement.
Bulbous tip after rhinoplasty
Your tip isn't going to get any smaller without surgery.Also you have a build up above the supra tip. I fix these closed which means it heals faster. It is a removal of the high are and thinning of the tip
I can understand you concerns after reviewing your photos. Your surgeon was conservative but the tip was worked on and there is some improvement. I do feel that you would benefit from a revision to have better refinement. You should not look overdone.
Would a Second Rhinoplasty Improve Shape of my Nose (Mainly Bulky Tip)?
From the photos, it appears that you may have developed a "polly beak" which is an over-accumulation of scar tissue along the supra-tip and tip of the nose. This is more common with nasal skin that is thick and oily. An open revision Tip Plasty as part of a Rhinoplasty with possible conchal cartilage ear graft placement and removal of this excess scar tissue would be recommended. Hope this helps.