Dorsal hump removal has caused a new and unsightly problem. While top hump was removed, the lower portion of my nose now protrudes giving me an unflattering profile. I probably need to consult a new plastic surgeon about revision possibilities. I am very unhappy. What can be done about this?
Protruding Lower Nose After Rhinoplasty
Doctor Answers 7
Correcting Unfavorable Profile After Hump Removal During Rhinoplasty
The profile of the bridge is created by both the nasal bones and the cartilage of the dorsal septum. During hump removal, both the boney hump and cartilaginous hump need to be reduced to create a favorable contour to the profile. If the bone is reduced but the septum is left too high, a "polly-beak" deformity can result in which the lower part of the bridge protrudes above the nasal bones and above the nasal tip.
This can be corrected during a revision rhinoplasty in which the height of the lower portion of the bridge is lowered to the correct level to create a favorable profile.
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Many different options exist for protruding nose
Assuming that the results are not the result of post-operative swelling, you need to determine if the reduced dorsum is appropriate and the tip is too projecting, or if the dorsum is too reduced requiring some type of augmentation. You also need to determine if the angle of the dorsum is too acute making you look like you have a birds beak.
1. If The dorsum is good - then drop the tip of the nose to fall in line with the dorsum. Techniques can include cutting and shortening the medial crura, lower lateral cartilage or defatting the nasal tip.
2. If you need dorsal augmentation - then grafts can include cartilage (ear, septum) Bone (Rib, Hip), fascia (scalp), combinations of the above, or synthetic (porex or silicone).
In any case these procedures require someone skilled in revision rhinoplasty.
Best of Luck!
Need more information
You may still have a lot of swelling depending on how long ago the rhinoplasty was done. The tip tends to stay swollen longest. However, if too much dorsum was removed, it may make the tip seem more projecting. Possible treatments include lowering the tip, or grafting to the dorsum to raise it and smooth out the profile. Graft material is obtained from the septum, the ear, or the rib.
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Probably some cartilage that was left in your nose
This is a common problem after removing the hump. It is likely that there were some cartilage that was left that can be taken off with a revision. Sometimes, the cause of this occurs when too much was taken off and you develop swelling above your nasal tip. This is called a polly beak deformity, although there are many reasons for a polly beak. You would really have to come to see us to have us really look at it. But don't worry all things can somehow be improved. There are people out there that can help you.
Consulting a Board Certified Facial Plastic Surgeon would be something that I recommend. We specialize in the face and are highly qualified to help you with this.
Nasal swelling is common after rhinoplasty especially effecting the tip of the nose. Give it at least 6 months before contemplating any revisions. Seek additional consultations with an experience rhinoplasty surgeon to ease your mind but I would not advise any surgery until satsifactory resolution of swelling.
Tip Rhinoplasty may help protruding nasal tip after Rhinoplasty
Wait 3-4 months for your swelling to go down and you may be much happier.
If after a few months you still feel the tip is out of balance with the rest of your nasal profile, a less extensive tip rhinoplasty and modification of the lower dorsal septum can often bring everything in to balance.
Be sure to discuss your concerns with your doctor.
Hard to tell soon after surgery
Without a picture, it is difficult to give you specific advice. However, if you are very early after surgery, you really should not make any rash decisions without waiting for the swelling to go down and the tissues to settle. The best start is to discuss your concerns with your current doctor. Good luck