Daniel Tran, MD

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

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

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

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

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