Do I Need Revision Rhinoplasty for Supra Alar Pinched Tip?

I had open Rhinoplasty 3 months ago. I think I have supra alar pinched tip, although the tip itself is not pinched. This is my picture, can you please confirm this? Do you think the tip itself is still swollen so it makes it look even worse?

Another thing, what is the cost and recovery process for a revision for this issue? Is it like the open rhinoplasty? Can I use fillers instead or is the pinching too deep? Sorry for all the questions but I am confused. Thanks!

Doctor Answers (28)

Revision Rhinoplasty: Not to be considered lightly or too soon

+3

My advice to patients is simple:  Rhinoplasty result takes a year to fully develop and consideration is usually not given to a revision for 12 months.  Rhinoplasty is a complicated procedure and revision Rhinoplasty more complicated still.  It is best to undergo surgery when the conditions are optimal for the best result when inflammation has subsided.


Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Pinched nasal tip

+3

Dear Samra,

First of all, I would absolutely concur with the other surgeons who have previously answered your question. You should wait until around 12 months after your rhinoplasty before considering revision rhinoplasty. As things settle out, you may find that you are no longer bothered by the appearance of your nose...

Obviously, I would need to examine your nose, both inside and out, to give you an accurate diagnosis. However, based purely on your photo, my suspicions are that you may be headed in the direction of having a pinched tip. Additional photos would certainly be helpful. This pinched tip may be a result of sutures which bind the tip cartilages, or "domes", together, changing the natural contour of these cartilages. In these cases, it's a matter of removing these sutures and reshaping your tip cartilages in a more normal, aesthetically pleasing way. I would do this through an open rhinoplasty approach. 

This type of nasal shape can also be due to your lower lateral cartilages being weaker than they need to be. This problem can be corrected with lateral crural strut grafts, which are cartilage grafts placed under your tip cartilages to support and strengthen them. 

You should bring up your concerns with your surgeon but be patient before proceeding with revision surgery. Good luck!

Kind regards,

Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

Do not Rush into Revision Rhinoplasty prematurely

+2

Hi Smara,

I know you might be disappointed, but you would be served best if you wait for one year before doing a revision rhinoplasty.

Three months is very early as your nose has a great deal of swelling and will continue to improve over the next 12 months.

Please try to avoid using fillers in the nose. It is not FDA approved and cause permanent discoloration and skin changes of your nasal skin.

Good Luck

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 117 reviews

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Timing of Revision Rhinoplasty

+2

As other plastic surgeons have already stated, one must wait an appropriate length of time even before considering revision rhinoplasty procedure. Three months is too early. The nose will continue change and gradually improves with time. Lastly, injectable fillers should not be placed in the tip of the nose due to significant risk of skin and cartilage damage. Speak with your rhinoplasty plastic surgeon for any concerns you may have. Best of luck.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 46 reviews

Revision rhinoplasty timing for decision

+2

3 months is much too early to make any decisions regarding revision. Furthermore, determination of the cause of the aesthetic issue is more complicated than meets the eye--it is really all about balance. Balance in contour from the top of the nose to the tip.  Imbalance in width can give the appearance of unusual/untoward narrowing or widening. Also, the contour of the nose is difficult to determine without proper standardized photography. 

Communicate your concerns with your surgeon, who should help guide you through this process. 

Hope this helps.

Sam Most, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Wait Before You Consider Revision Rhinoplasty

+2

First and foremost, it is too early for you know whether or not you should consider revision rhinoplasty. The nose will undergo significant changes during the first several months after rhinoplasty. As the swelling goes down, you may be more pleased with your results.

The general consensus among rhinoplasty specialists is that a patient wait for 12 months before proceeding with any revision. The reason for this is that it can take 12 months (or longer) for the majority of the post-operative swelling to subside and for scar tissue to mature.

Residual deformities following a rhinoplasty can vary in severity. For minor deformities or depressions, a "Non-Surgical Nose Job" using injectible filler substances can help camouflage the problem.

Occasionally, the problems are more pronounced and require additional surgery. Revision (secondary) rhinoplasty is more difficult than primary rhinoplasty and requires more expertise. It is therefore important to select a highly qualified surgeon who is experienced in secondary rhinoplasty when the revision of a previous nose job is required.

The cost of revision rhinoplasty can vary significantly depending on what needs to be done to correct the problems with the nose. Sometimes a revision is a minor undertaking and can be accomplished in the office with local anesthetic. Most surgeons will correct imperfections that weren't adequatelty addressed or arose from the original surgery for their own patients at no additional charge. This is something that varies from practice to practice.

If you are seeking a complete "re-do" by another surgeon, the cost can range from $6,000 to $25,000. With major structural deformities, cartilage grafts are required to rebuild the nasal framework. Septal cartilage, while the preferred source of cartilage grafts, has usually been depleted during the first operation. Revision Rhinoplasty Surgeons then have to "borrow" cartilage from another part of the body - such as the ear or rib. This increases the operative time and cost.

Speak with your surgeon about your concerns regarding your tip deformity. If you do not feel comfortable with the surgeon who performed your surgery, you should seek the advice of a rhinoplasty specialist who has expertise in secondary (revision) rhinoplasty.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 90 reviews

It's still too early to tell

+2

Samra,

3 months is still too early to tell what your final result will be. Swelling often persists in the tip for several months, up to a year after surgery, and this alters the appearance of the early results. I have found that in some patients, the swelling can be even a bit worse with open rhinoplasty compared to closed, so I think patience is very important at this point.

Costs for revision surgery are variable and depend on several factors, including your agreement with the surgeon who did your first procedure (sometimes they will offer a revision if one is needed at a reduced fee). I would imagine if you go to another surgeon you will likely be asked to pay his full standard fees.

Fillers may be an option, but again it's really way too early to tell.

My advice is to wait at least a year before letting anyone touch your nose; at that time, if you are still interested in another opinion, I can offer you a name or two of some outstanding rhinoplasty surgeons in the DC area who are experienced in revision surgery.

Good luck!

Dr. Salemy

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 94 reviews

rhinoplasty for supra-alar pinched tip

+1
 Even though it's been 3 months since your open rhinoplasty, the nose is still not fully healed. After open rhinoplasty the tip continues to stay more swollen since the lymphatics have been altered. Do not attempt to undergo revision rhinoplasty for at least one year after the initial procedure. If there is supratip edema  present, then cortisone shots to the supratip area of the nose and Blenderm tape used at night can help prevent fluid retention in this area.
 For many examples of rhinoplasty, please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

Some Aspects of a Nose Cannot Be Changed

+1

It's VERY important to realize that there are some features of a nose that cannot be changed -- and therefore some people will never get the ideal nose that they dream about. In other words, you can't make any nose out of any nose. Two of these unalterable features are the overall length of the nose from the brows down to where the columella attaches to the upper lip. Another is the vertical height of the lateral ala (the part that attaches to the face), the shape of which is made up of and determined by fibro-fatty tissue, not just cartilage and skin (like the tip and medial ala). In your case, both of these anatomical features are proportionately too long, and therefore you will never have ideal nasal features and proportions. My concern is that you are seeing things that you still don't like about your nose, but not really knowing what they are exactly. I suspect that what you are "sensing" are the disproportions I just described.

The message is this: There are some things about our bodies that cannot be made ideal through surgery -- and we all just have to try to learn to live with those things and love them as much as we can. Beware the Michael Jackson syndrome -- where you keep trying to chase an ideal that cannot be achieved -- and end up with something worse than what you started with.

Richard Parfitt, MD
Madison Facial Plastic Surgeon
4.5 out of 5 stars 16 reviews

Nonsurgical revision rhinoplasty may suffice.

+1

Dear Samara;

Because it has been six months since the rhinoplasty surgery, most likely there are not going to be any automatic major improvements.  Now, it is wise to wait a few months more if there is any question; it is not wrong to wait up to a year.

However, has your plastic surgeon considered the possibility that a nonsurgical revision rhinoplasty, consisting of using a filler to correct a depression, might not suffice?  Without seeing you, it is difficult to tell.  If the main problem is that some cartilage is "too high," the filler may not be appropriate because it might make the adjacent area too large.

However, if, in reality, one area is high because the adjacent area is low, then there is wisdom in filling the lower area to see if it meets the heights of the high area.  The mountain looks shorter if you fill the valley next to it.

You should consider that and discuss it with your rhinoplasty surgeon.  You could even have a "saline demo," whereby sterile saltwater, the same type that is used for intravenous infusions, is injected to show the predicted result of the ultimate filling.  The saline will dissipate within an hour or two, but at least while it is there you will have a good idea if success can be achieved without another surgical session.  It makes sense because:

  •    It is an in-office procedure
  •    There is no downtime
  •    The results are what you see
  •    Less guesswork is in play

Injection rhinoplasty not be appropriate for you, but it is something that you should consider.

Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 56 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.