Felipe Amaya, MD

Cartilage grafts at the tip of the nose typically take time to soften and adapt to their new environment. This process can vary from several weeks to several months, depending on factors such as the surgical technique, the location of the graft, and the individual patient's response. Generally, most of the softening and remodeling of the cartilage occurs in the first six months, but complete maturation can take up to a year or more.

In some cases, the grafts may remain pointed if they do not integrate properly or if there is not enough soft tissue to cover them. To camouflage any irregularities at the tip, the use of fascia (a connective tissue that can be taken from other areas of the body) is an option. Fascia can help provide a better contour and soften the appearance of the cartilage graft, as well as promote a more natural integration with the surrounding tissues.

It is relatively common to experience some sensation of pressure or tightness in the nose up to a year after rhinoplasty, especially after removing a bump. The structure of the nose continues to adjust and remodel, and internal scar tissue keeps maturing. This pressure sensation can be due to internal healing, where tissues and cartilage are still stabilizing, and it usually decreases over time.

However, if the pressure persists or worsens, it might be helpful to consult your surgeon again to rule out any issues, such as excessive scar tissue development or changes in structural support. Although rare, in cases of structural weakness, a collapse could occur, though this would usually present with additional signs, like difficulty breathing or a noticeable change in the external shape of the nose. Your doctor can perform an examination and possibly imaging to assess the internal condition if needed.

Alar base reduction, if not performed precisely, can alter the appearance and structure of the nostrils. In some cases, it may create the impression that the nostrils are more sunken or widened if too much tissue is removed or if the closure technique doesn’t adequately support the structure. This happens because the alar base supports part of the shape and contour of the nostrils, and reducing it without proper balance can create a less natural appearance.

An excessive nasal sill (the visible area between the alar wings and the nasal tip) can also influence how the alar wings are perceived. If the sill is too prominent or wide, it can create the impression that the alar wing expands or becomes distorted, and it may also give a stretched appearance to the nostril, especially when smiling or making facial expressions.

I understand your concern. Changes to the jaw and facial contour after orthognathic surgery can indeed alter the proportion and perception of other features, such as the nose and nasolabial groove. In your case, the widening of the nose and increased visibility of the nostrils may have become more pronounced due to the new jaw position, creating a sense of imbalance.

A rhinoplasty could help harmonize the appearance of your nose with your new facial structure. This procedure might refine the nose or adjust its projection and rotation to better complement your face. As for the nasolabial groove, it may also appear longer due to the change in facial proportions; however, a lip lift might not be ideal if, as you mentioned, your nose angle is not favorable for it.

Pressing the area of the bump may be suggested to help reduce mild swelling or adjust small deposits of scar tissue, which can sometimes improve appearance without surgical intervention. However, this approach is generally more effective in the early postoperative months and only if the bump is soft and responds well to pressure.

As for discomfort, pressing may cause some mild discomfort but should not produce bleeding. If the bump is firm, it could be a small bone or cartilage irregularity, in which case pressing may not provide much benefit.

The best course of action is to consult your surgeon so they can evaluate the texture and nature of the bump and confirm if this method is appropriate for your case.