Rhinoplasty

Hello rgilbert1111, 
Great question! I agree that it is possible this is not a polly beak deformity. It is a little early to tell. However, you do have some swelling in your tip and it's hard to tell at this point whether this is due to soft tissue swelling/early scar tissue or the shape of the lower lateral cartilages themselves. It is definitely reasonable to consider steroid injections to the tip of your nose. The tip retains swelling the longest and I often consider steroid injections to the tip and supra tip areas up to a year after surgery. It may take a few rounds of injections but if this is indeed related to soft tissue swelling, you'll start to notice a reduced size and improved definition to the tip. If it does not improve, you may consider revision rhinoplasty to reduce the tip or augment the bridge/dorsum as one of the other surgeons mentioned.
I hope that helps. Good luck!
Daniel Tran, MD Facial Plastic Surgeon Washington, DC

I had a rhinoplasty about 6 months ago and notice that my nose is still a little upturned and looks like it’s forming polly beak deformity. I just had a Kenalog injection for allergies on my hip/butt area. Will this help with the inflammation and polly beak deformity on my nose? Update: Additional photos added

Polly beak formation 6 months after rhinoplasty. Will kenalog injections help? (Photo)

Hello daisies900, 
This is a great question and I'm glad you're seeing your surgeon next week. Oftentimes we use different columellar and septal grafts to change the rotation of the tip and prevent the columella from hanging or drooping. These can vary from columellar strut grafts to septal extension grafts, tongue-in-groove, plumping grafts, etc. It is possible that a graft is resorbed or there is loss of some of the tip support mechanisms. As the rotation changes with the tip drooping down, you will lose some of that slope you used to have. I would definitely bring it up to your surgeon and show him/her the exact photos you posted on here. I always appreciate when my patients are completely open with me about their results. Besides, your surgeon is going to know exactly what graft they put in there and how to possibly fix it. If they are not helpful, I would just make sure to ask for the operative report so that any surgeon you see for a second opinion can come up with an accurate plan to address your concerns.
I hope that helps! Good luck!
Daniel Tran, MD Facial Plastic Surgeon Washington, DC

I am noticing what appears to be swelling to my columella (never had before) and tip (was previously almost resolved). I had steroid injections and needed filler to correct small dents (bridge, tip). Now appearance is straight instead of sloped, which I hate. The filler was 6 mos ago, and just last month I noticed my columella was drooping when smiling. I am very concerned and don't know how to bring this up with my MD. I see him next week.

New swollen/droopy columella 2 years s/p rhinoplasty (Photo)

Hello Giving996032, 
This is a great question! I agree that steroid injections early on can prevent scar tissue (hypertrophic scarring, keloid) from forming again. Oftentimes, I will inject steroids right when I remove the scar tissue while still in surgery. After that, I would see you back every couple weeks to re-evaluate and consider injecting again if there are any signs the scar tissue is trying to come back. Silicone sheets could help but that is a really hard area to get the sheets to stick and stay in place. 
Good luck! I hope that helps!
Daniel Tran, MD Facial Plastic Surgeon Washington, DC

I have scar tissue inside both of my nostrils where the incisions were. My doctor said that he can remove the scar tissue, but that the scar tissue might come back. What can I do to prevent the scar tissue from coming back? Can I use silicone scar sheets inside my nostrils?

How to prevent scar tissue from growing back after rhinoplasty?

Hello ChrySler, 
Thanks for the great question! It is possible you have a deviated septum. You may be feeling your bony septum or nasal spine. This can happen even without breaking your nose or any trauma in the past. This can be perfectly normal. I would say many of my patients don't even realize they have a deviated septum until I put a scope or camera in their nose to show them. If you don't like the way your nose looks or are having problems breathing out of your nose, I would go see your facial plastic surgeon, ENT surgeon, or plastic surgeon and have them evaluate whether you may be a good candidate for a septoplasty or rhinoplasty.
Hope that helps! Good luck!
Daniel Tran, MD Facial Plastic Surgeon Washington, DC

I stuck a pinky finger in my nose earlier. My right nostral was fine but. I could only get up to my nail in my left nostril. I hit a bone Id say its about a half inch from the opening of the nostril. And I never broke my nose ever

I hit a bone inside my nose. Is my nose normal? (photo)

Hello adz123, 
This is a great question that I get asked a lot in my practice! There is a muscle that is responsible for pulling the tip of your nose down when you smile. It is called your depressor septi nasi muscle. Many times when my patients have a dynamic tip that moves down when they smile, I make sure to release this muscle during surgery. By releasing the muscle, your tip no longer pulls down. When you are discussing your concerns during consultation with your surgeon, you can tell them just what you mentioned: that you don't like the tip rotating down and that will ensure they address it during rhinoplasty surgery. 
In terms of your ala cartilage, if it is too wide or too defined when you smile, an alar base reduction or alarplasty can be done. This can be done as a part of a routine rhinoplasty surgery as well. I discuss alar base reduction with all my rhinoplasty patients because often times when I reduce the nose and make it smaller, it causes the alar to flare more and an alar base reduction/alarplasty needs to be done to keep the face well balanced. I perform alar base reduction in about 30% of my rhinoplasty patients.
I hope that helps! Good luck!
Daniel Tran, MD Facial Plastic Surgeon Washington, DC

To whom it may concern, I like my resting face, but once I smile it looks very different and I am unhappy with it. Firstly, my nose when my face is lifted up and not smiling I like it, but once I smile or tilt my face downwards, I notice that my bulbus is larger and makes my nose point downward, this is ofcourse the same with my side profile. I understand that when you smile your nose widens but I dont like how defined my ala is. What should I be asking for?

My nose and chubby cheeks are not helping my smile (Photo)

Daniel Tran, MD

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Dr. Dan was professional, kind and empathetic. He was more than willing to answer all my questions and address any concerns I had since I was a first time patient. I will absolutely be a returning patron.

Great experience - I will absolutely be a returning patron

Polite5311

I went through a messy divorce and needed to do something for myself. I decided to have a facelift and was recommended to Dr. Tran. I’m so happy that I did, not only did he give me back my life and make me feel better about myself again, he also did an amazing job. My face looks amazing and I would recommend him highly to anyone.

My face looks amazing

Charming728814

5 Answers from Board Certified Otolaryngologist Daniel Tran, MD See Education, Board Certification, and Treatments Offered.

Learn about Daniel Tran, MD. Read real patient reviews, see before-and-after photos, and get expert insights. Explore more on RealSelf!

Otolaryngology, 2016

Facial Plastic Surgery, 2023

United States Military Academy at West Point - B.S., 2003

University of California, San Francisco (UCSF) - M.D., 2007

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Daniel Tran, MD, Board Certified Otolaryngologist | Real Patient Reviews, Before & After Photos, Expert Answers - RealSelf

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