Do I Need Revision Rhinoplasty for Supra Alar Pinched Tip?

Unfortunately you are in good company. Most rhinoplasty patients out
there are very unhappy with their results in 1-2 years. The explanation
for this is very simple: Most surgeons performing rhinoplasty do not
have advanced training or experience, they perform the rhinoplasty of 50
years ago. Decades ago thought process of rhinoplasty was to remove
cartilage to refine the shape of the nose and perform it through an open
approach. An open approach makes it easy for neophyte surgeons to
access visualize and manipulate the structures but also unnecessarily
destroys two arteries and veins that are important for nasal
vascularity. The open approach thus ensures that patients have 1-2
years of risidual swelling which hides the final result. Most
rhinoplasties out there I consider cartilage robbing thus when the
swlling resolves there is inadequate structure to provide aesthetic
appearance and fight the cicatriacial forces or the continued scarring
that results from the lowered oxygen tension and fibrosis of tissues.
One additional problem it that most rhinoplasty surgeons out there
inadvertently break the connection between the bony nose and the
cartilagenous nose. this can cause irregular narrowing and what we
calll "the inverted V deformity" which means the outline of the nasal
bone becomes visible through the skin particularly in flash photography
under certain lighting conditions.In my opinion, an expert
level rhinoplasty is always performed in a closed technique and ALWAYS
involves grafting to add to the structural integrity of the nose. The
act of opening the nose even under the closed technique causes healing
and some contraction, thus for a long term beautiful result the nose
must be left more structurally sound than it was found. This is missed
upon most rhinoplasty surgeons. In secondary cases such as
yours it is even more crucial that sound grafting techniques are used.
Definitely do not consider any rhinoplasty procedure that does not
include grafting preferably by an experienced Plastic and reconstructive
training with ddition fellowship level craniofacial and aesthetic
training. Of course this is my bias because it is my training but I
think this level of training is very necessary for success in secondary
and tertiary rhinoplasty because there is delicate nuance involved and
every patient requires different maneuvers. I hope this helps!All the best,Rian A. Maercks M.D.

A pinch tip or supra-tip could be the consequence of per-existing pinch, suture techniques or excessive reduction of the nose cartilages specially on a patients who have convex tip cartilages that are oriented upwards. The solution is surgical correction of the problem for a permanent improvement after about a year following the initial surgery. Unfortunately, waiting is not going to correct the pinched tip or supra-tip pinch. Actually, it may get worse over time as the swelling subsides. The reason for waiting for about year is that with the healing other imperfections may develop and an early surgery my necessitate a second revision because of the other problems that cannot be seen at this time. If the pinch deformity is troubling you enough, it can be corrected temporarily with the fillers until you are ready for the final operation. You may consult your surgeon about the use of fillers to allow the final correction when the time is right.

 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