Ali Sajjadian, MD, FACS

Thanks Charming657132 for your question! It's understandable that you're feeling discouraged and experiencing low self-esteem after two rhinoplasty procedures have not yielded the results you hoped for. Swelling after rhinoplasty, particularly revision rhinoplasty, can last a long time. While the majority subsides within the first year, some residual swelling, especially in the tip, can linger for several years. This is due to the complex nature of healing, particularly when dealing with prior scar tissue and altered anatomy from previous surgeries. Fluctuations in swelling can occur due to various factors, including diet (high sodium), activity levels, and even weather. It's possible a significant portion of what you're experiencing is indeed persistent fluid and inflammation. Revision rhinoplasty often involves working through existing scar tissue from the initial surgery. While the surgeon aimed to remove scar tissue, the body's natural healing response can lead to the formation of new scar tissue. Excessive or unpredictable scar tissue can contribute to increased size and firmness, sometimes giving the appearance of a larger or less refined nose. The second surgery involved "more septal work" and potentially removing more from your tip. While intended to improve the shape, these changes, combined with healing and scar tissue, could have led to unforeseen structural support issues or contours that contribute to the perception of increased size. The healing process after any surgery, especially revision rhinoplasty, is highly individual and not always entirely predictable. The way your tissues responded to the trauma of two surgeries could be a factor in the current outcome. Given your history and dissatisfaction, seeking a second opinion from another qualified plastic surgeon, particularly one specializing in complex revision rhinoplasty, is highly recommended. A new surgeon will evaluate your nose and surgical history with a fresh perspective. They may identify factors or potential approaches that your previous surgeon did not consider or feel comfortable undertaking. Revision rhinoplasty is significantly more challenging than primary rhinoplasty. Surgeons have varying levels of experience and expertise with different techniques for addressing issues like persistent swelling, scar tissue, and structural support in previously operated noses. A surgeon who specializes even more narrowly in complex revisions might have solutions or strategies that could be beneficial. Prioritize finding a surgeon with extensive experience specifically in revision rhinoplasty and a strong track record of managing challenging cases. Look at their before and after photos of revision patients and have a very open and detailed conversation about your concerns and their assessment of what might be possible. It really takes at least 12 -24 months for healing to complete itself after Revision rhinoplasty. Hope this was helpful! Best wishes, Dr Ali Sajjadian

Thanks Stpjcq for your question! It really takes at least 12 -24 months for healing to complete itself after Revision rhinoplasty. Revision rhinoplasty is frequently an option for those who have had rhinoplasty surgeries in the past and are having problems like unequal nostrils and a hanging columella. But given the case's complexity—especially given the history of severe bleeding, the development of scar tissue, and thick skin—careful thought and consultation with a highly skilled revision rhinoplasty surgeon are necessary to fully understand the possible outcomes and the surgical strategy. The present asymmetry and the appearance of the columella arcould be influenced by the history of severe bleeding and scar tissue. The form and symmetry of the nostrils as well as the location of the columella can be affected by scar tissue's ability to compress and distort the skin and underlying cartilage. As previously indicated, thick skin can also affect the result of rhinoplasty since it may not redrape over the new framework as readily and can occasionally make it difficult to see the definition of the underlying structures, such as the nostrils and tip. The fact that the prior attempt to lessen scarring with hydrocortisone injections did not result in a noticeable improvement raises the possibility that the scar tissue is thick or mature, making revision more difficult. Issues from prior nose operations are especially addressed with revision rhinoplasty. A surgeon may need to release scar tissue, reposition or reshape cartilage, or utilize grafts to fill in missing portions and enhance symmetry in order to fix unequal nostrils. In order to produce a more balanced connection with the nostrils, methods for a hanging columella may include cutting the septum shorter, moving the columellar cartilages, or removing extra tissue. Although the main objectives are to smooth out the nostrils and fix the dangling columella, people with thicker skin may find it more difficult to achieve noticeable definition in the tip and nostrils when compared to people with thinner skin. In addition to being more likely to enlarge and create scar tissue, thick skin can make it harder to see minute alterations to the underlying cartilage. Nonetheless, proficient revision surgeons possess methods to improve tip definition in individuals with thicker skin, sometimes utilizing robust cartilage grafting to offer superior structure and support. A comprehensive consultation with a board-certified plastic surgeon who specializes in revision rhinoplasty is essential. Hope this was helpful! Best wishes, Dr Ali Sajjadian

Thanks Intuitive567960 for your question! It sounds like you're experiencing some frustrating issues after your open rhinoplasty. It's quite reasonable that, despite your general satisfaction with the design, you're looking for solutions to deal with the stiffness, blanching, and asymmetry. It really takes at least 12 -24 months for healing to complete itself after Revision rhinoplasty. Your nasal tip's rigidity, lack of mobility, and blanching when you smile could be caused by a few things: It could be that a cartilage graft was inserted in the tip to provide it stability, definition, or structure because you stated that you were unaware that one had been used. Grafts sometimes can feel hard and less mobile than your natural tissue, even though they are necessary to achieve some functional and aesthetic results. Scar tissue can form excessively both internally and outwardly during the healing process following rhinoplasty. This scar tissue may cause the skin to become rigid and tethered, which would limit mobility. The skin may feel tight as it redrapes over the changed underlying structure, particularly at the tip where the alterations are frequently more noticeable. When you smile, the muscles surrounding your nose and upper lip work together. If a graft or scar tissue has made the tip structure more stiff, the skin stretching over it may blanch because the tension will temporarily block blood supply. Under this stretched skin, the prominence of the underlying cartilage is more apparent. Steroid Injections: To assist soften the region and lessen scar tissue, a surgeon may think about injecting a tiny quantity of corticosteroids into the tip. This method is frequently used to treat stiffness following rhinoplasty, but it must be done carefully to prevent skin thinning. Small or moderate amounts of 5_FU can also be used with success. Rhinoplasty Revision: Revision rhinoplasty may be a possibility if the blanching and rigidity are really affecting your pleasure. To increase mobility and lessen skin strain, this would include surgically correcting the underlying graft, scar tissue, or tip structure. Because this is a more complex procedure, it's critical to set realistic expectations and locate a highly skilled revision rhinoplasty surgeon. At 14 months following your treatment, it's a good idea to see a Board-Certified Plastic Surgeon with expertise in revision rhinoplasty. They will be able to: Conduct a comprehensive examination of your nose and identify the cause of your stiffness, blanching, and asymmetry. Consider your first surgical plan and the techniques used.Talk over the advantages and disadvantages of each possible corrective option in detail. Set reasonable goals for what more involvement can accomplish. Bringing pictures of your nose from before your original surgery and current ones that show the trouble spots is beneficial. For any possible revision, be ready to talk about your medical history and your objectives. Hope this was helpful! Best wishes, Dr Ali Sajjadian

Thanks Sensible253192 for your question! The surgeon's main goal in a typical, skin-only facelift is to redrape and remove extra skin. Because the underlying support structure (the SMAS and deeper tissues) isn't addressed, the skin may relax and sag again quite fast, even though this may initially provide the appearance of tighter skin. Comparable to tightening a slack clothing without modifying the underlying structure, the fabric may appear taut for a time before sagging once more. The SMAS (Superficial Musculoaponeurotic System), a layer of tissue covering the facial muscles, is released and repositioned during a deep plane facelift. The surgeon can accomplish a longer-lasting and more natural-looking lift by targeting this deeper layer. After that, the skin is redraped over this enhanced foundation, which relieves tension and lessens the chance of premature skin relaxation. The lifespan of any facelift, whether deep plane or skin-only, depends on a number of variables, including as skin elasticity, lifestyle, and heredity. After a facelift, it's normal to worry about possible side effects including hemorrhage, stiffness, and hardness. Although the incidence and severity of these adverse effects might vary based on the type of facelift and personal circumstances, they are absolutely feasible. Deep plane facelifts include greater manipulation of deeper tissues and blood vessels, which increases the risk of hematoma. While skin-only facelifts have a lower risk, it's not entirely eliminated. Following any facelift, hardness and stiffness are often expected as the tissues settle and heal. However, if there is a lot of strain on the skin, which is more likely to happen with skin-only facelifts if the underlying support isn't addressed, excessive tightness and persistent hardness may result. Although your worries are legitimate, getting a skin-only facelift just to stay away from these hazards might not be the best course of action. Weighing the possible advantages and disadvantages of each procedure is crucial, as is having a full conversation about them with a skilled board certified plastic surgeon. They can evaluate your particular situation and suggest the best course of action to meet your objectives while lowering risks. Hope this was helpful! Best wishes, Dr Ali Sajjadian

Thanks Lilla29 for your question! It's understandable that you're looking for solutions to address the saggy skin you're experiencing. It's frustrating when a procedure doesn't deliver the desired results, as it can be emotionally and financially taxing. The mid-face is the main goal of cheek lift surgery using an under-eye incision, which raises and realigns the cheeks to enhance volume and definition. To reduce obvious scarring, the under-eye incision—also referred to as a transconjunctival approach—is frequently utilized. It can successfully treat drooping cheeks and enhance the appearance of the area beneath the eyes, but it might not be enough if your neck and lower face have a lot of loose skin. The superficial musculoaponeurotic system (SMAS), a layer of tissue supporting the skin and facial muscles, is one of the deeper tissues and systems of the face that are targeted by a deep plane micro facelift. It gives the neck, lower face, and midface a more thorough lift. A broader variety of issues, such as jowls, neck laxity, and drooping cheeks, can be addressed by it. is more intrusive than a cheek lift and has a longer recovery time, but it provides a more natural-looking and long-lasting outcome than a standard micro facelift. Since your neck and lower face appear to have a lot of loose skin, a deep plane micro facelift would be a better choice than a cheek lift. Selecting a board-certified plastic surgeon with a wealth of cosmetic surgery experience is essential. Make appointments with a number of board-certified plastic surgeons who focus in face operations. Talk about your objectives, goals, and concerns throughout your sessions. After evaluating your face structure, the surgeon will suggest the best course of action for you. Hope this was helpful! Best wishes, Dr Ali Sajjadian