Selcuk Yazan, MD

Thank you for your question.

This is thoughtful, important and often comes up. Whether or not to pursue a revision is a personal decision. If your nose is functioning well and you’re generally satisfied, there’s no medical reason a revision must happen. If the asymmetry or contour of the tip is something you find distracting or that doesn’t feel like you, it’s absolutely reasonable to explore revision or refinement options.

What’s important to understand is that rhinoplasty is one of the most commonly revised procedures in aesthetic surgery. In fact, most noses could benefit from a touch-up. That’s not a reflection of poor surgical technique, it’s a reflection of how complex and dynamic the nose truly is. If every surgeon shared this openly, many patients might hesitate or go searching for someone who promises a perfect “one-and-done” result. However, the reality is, healing is not always predictable. A surgeon can do everything right in the operating room, but the nose might not heal exactly as planned. Swelling patterns, scar tissue, and even how you sleep can cause subtle shifts over time.

It’s also important to know that a nose can only be downsized or reshaped so much in one surgery. The skin has to adapt to what’s underneath it, and especially in patients with thicker skin or a more complex starting point, there are limits to how far a result can be pushed safely in a single operation. Sometimes the desired outcome isn’t achievable in just one step, not because the surgeon didn’t go far enough, but because the body needs time to respond and adjust. That’s when a second, more refined stage can bring everything into place.

Small refinements are rarely as simple as they sound. The nose works like a tripod: if you change one area, the rest has to adjust to stay balanced. For example, making one side of the tip less bulbous can affect rotation, symmetry, and the overall alignment of the bridge. What may appear to be a small revision might actually require addressing the full structure to achieve harmony.

A nose is also comprised of 2 nostrils and a tip which requires being centered. The slightest deviation inside may cause asymmetry. This requires opening the entire nose and changing many parts just to correct a millimeter on the exterior.

The nose is also a living, breathing organ that’s constantly in motion. It changes with emotion, breath, and expression. The muscles around it help you emote as well. Inside, the turbinates swell and shrink throughout the day, and you might notice one side appearing more full just from how you slept (suppressing one sides turbinates.) When you are happy and you smile, you take in more oxygen. A nose will never look exactly like it did in the operating room or in early post-op photos because it’s constantly responding to your body and your life.

So is a revision warranted? Only you can answer that. Your experience is common, your observation is valid, and that seeking refinement is a normal and respected part of the process.

Thank you

Thank you so much for sharing your story. What you’ve described is something we see more often than most people realize. That kind of sudden fluctuation, especially when tied to something like a thyroid imbalance, can certainly affect the skin’s elasticity, particularly under the chin and around the central neck.

While it might seem like a small area, the neck is closely connected to the lower face in terms of structure and support. If only the skin beneath the chin is tightened surgically, the lower face may appear unsupported. This can lead to an imbalance in appearance. Similarly, tightening the neck without lifting the surrounding areas often doesn’t hold well or feel harmonious long-term.

It’s typically advised in these cases, to gently lift the face, neck, and central neck together to restore a natural contour and structural balance. It’s not about doing more than needed, it’s about approaching the area as a connected whole, so your result looks seamless and age-appropriate.

In many cases, the best outcomes come from treating these areas as a unit. This is not for dramatic change, but to restore balance and harmony in contour.

It’s not uncommon for patients in younger ages to consider and benefit from these lifts, especially when elasticity has been impacted by medical or weight changes. It’s a modern, elegant approach designed for patients who simply want to look like the best version of themselves, not different, just restored.

Factors like skin elasticity, genetic structure, and prior changes to the tissue (such as with fillers or other treatments) all play a role. The concept of facial lifting is no longer about dramatic change in later years, but rather about subtle, individualized restoration when the patient feels ready and has determined it’s the right time along with their chosen provider.

Thank you for asking this question. The changes you’re noticing don’t mean something is “wrong”, they’re simply part of how weight loss, muscle tone, and support structures shift over time. It’s completely valid to notice a shift in how your face and neck feel, even if the change is difficult to pinpoint.

In younger patients, changes in the neck and jawline are often not about aging, but rather about how support structures beneath the skin respond to things like volume loss, Botox, and even strong muscle activity.

The platysma, the thin sheet-like muscle in the neck, can sometimes lose tension or pull differently when fat volume decreases or when Botox is used repeatedly. While Botox softens visible banding, it also weakens the muscle’s tone, and in some cases, this can make the overlying skin appear looser. When combined with fat loss, the skin no longer has the same underlying support, which can make small shifts more visible.

This isn’t necessarily a sign that anything is wrong, it’s just the body’s natural response to change. The muscles and tissue are adapting.

In terms of treatment, a neck lift for someone your age wouldn’t be about “anti-aging” in the traditional sense. It would be more about redefining structure, addressing subtle laxity that fillers and Botox alone can’t, reshaping the platysma, restoring support, reducing width or fullness if needed, and refining the overall contour. It’s closer to sculpting than fixing, and often about reestablishing balance, not chasing youth.

We hope this offers some clarity around what may be happening beneath the surface. The most important takeaway is that feeling out of balance doesn’t always mean surgery is the answer. However, when surgery is considered, it should be approached with precision and understanding of what’s actually shifted underneath, not just what’s visible on the surface.

Thank you for your message and for sharing your observations. From what you’ve described, it sounds like you have a very refined and well-balanced result. This is something that is truly a success in the world of rhinoplasty! When both the aesthetic and functional outcomes are positive, a revision is rarely recommended, and pursuing perfection isn’t usually beneficial.

That said, your comment about the columella appearing unusually straight brings up an important opportunity to talk about what contributes to a result feeling “natural.” While a straight columella can seem ideal, sometimes it may signal something more subtle. In some cases, it may be that the columella is slightly over-projected, which can create the impression of added length between the base of the nose and the upper lip (the philtrum.)

This is where lip lift surgery may become relevant. Despite its name, a lip lift isn’t about enhancing the lips themselves. It’s a delicate, structural procedure that reduces the height of the philtrum, slightly decreases nasal projection, and helps restore balance between the nose and mouth area, especially in the context of rhinoplasty.

Procedures like tip rotation can also draw attention to the philtrum or columella in a way that wasn’t visible before surgery. When that happens, the shift is not necessarily due to any flaw in the rhinoplasty, but to the natural interplay between features. A surgeon who understands both procedures is best positioned to recognize this balance and adjust accordingly.

It’s also worth noting that pursuing more procedures does not make a result less natural. In fact, combining smaller, well-considered procedures often results in a more harmonious and understated outcome. Natural-looking results are often the product of thoughtful refinements, not minimalism for its own sake.

Lastly, it’s important to acknowledge the stability of your outcome. Straight cartilage, when achieved in rhinoplasty, is structurally reliable and less prone to shifting over time. Cartilage that has a natural curve, bend or deviation often attempts to revert to its original shape, a concept known as cartilage memory, so when straightness is achieved and maintained, it’s something to be valued!

We hope this brings some clarity and offers perspective on how subtle shifts in structure can influence overall facial balance.

Thank you for your thoughtful question. This is an important topic, especially for patients who have previously had non-surgical skin tightening treatments like Thermage.

Thermage works by delivering radiofrequency heat energy into the deeper layers of the skin, stimulating collagen contraction and a modest degree of tightening. While this effect can give a temporary improvement in skin firmness, it does so by applying controlled thermal injury to the tissues.

This is where I invite patients to reflect more deeply. What does it mean to create change in the face by “burning” the deeper layers of your tissue?

Heat-regardless of how precisely delivered, does cause cellular damage. It contracts tissues, yes, but it also destroys some of the very structures we depend on for natural elasticity, smooth healing, and layered anatomical integrity.

So can you still have a facelift after Thermage? Absolutely. However, the anatomy can be slightly different in areas where thermal energy has been used. The tissues may respond differently or be more fibrous in certain planes. For this reason, it’s especially important to work with a surgeon who is highly experienced in facial anatomy, facelifts, and revision procedures.

In most cases, an experienced surgeon will still be able to perform your facelift smoothly and safely. The dissection may require more care, but when approached thoughtfully, it does not necessarily lead to a higher complication rate. In fact, in skilled hands, the procedure can still be effective and uncomplicated.

It’s always a best practice for surgeons to take the time to evaluate your unique facial history, understand the impact of any past treatments, and tailor your surgery accordingly.

Best of luck and happy healing.