Umang Mehta, MD

sorry to hear about your disappointing outcome from your rhinoplasty. from the profile view you posted, i agree that your nose is too upturned and your bridge is irregular/bumpy. the biggest thing that would help bring your tip down again is a caudal septal extension graft. this could be made from cartilage from your septum, rib, or cadaver rib. with more views of your nose, i could better counsel you about other maneuvers to improve your results. there’s nothing that you did wrong in your aftercare that caused this outcome. with modern techniques, i think your nose could be improved dramatically. make sure to see some surgeons who specialize in revision rhinoplasty and have made this the primary focus of their practice. best, dr. mehta

thanks for the question. i’d recommend having the filler dissolved followed by a consultation with a surgeon who specializes in revision rhinoplasty. the scar tissue can be directly removed during surgery and your skin can be thinned. your tip can be refined with advanced tip suture techniques. after surgery, you may need a combination of low dose accutane and steroid injections to further improve your results as the swelling goes down. overall, it looks like you are a very good candidate for surgery, but i’d recommend seeing an expert, as you want to make sure your next surgery is your last one! best, dr. mehta

Hi and thanks for the question. Sorry to hear about the difficulty you’ve had with your nose. It does look like your tip is still bulbous in the photos. The scar tissue and edema should be treatable with Kenalog injections… I use these commonly in my practice. The tip shape can also be improved by reshaping the lower lateral cartilages with modern suture techniques and removing some of the soft tissue directly. It may be that the current tip grafts are a bit wide and thick. Assessment of your tip could best be done with an in-person consultation, to assess how much of the issue is cartilage vs. swelling/scar tissue. All the best! Dr. Mehta

Thanks for the question. It looks like your bridge and tip are both deviated to the right. This is not due to scar tissue but rather your nasal bones and the top of the septum being off center. Straightening these out can certainly be achieved in a revision rhinoplasty. There are ways to reduce the swelling more quickly (steroid tablets, steroid shots) if you were to undergo another nasal surgery. If desired, your tip could also be made more refined and symmetrical at the same time. Kind regards, Dr. Mehta

Sorry to hear you had a negative outcome from buccal fat removal. You can replace the lost volume with a long lasting collagen stimulator like Sculptra which can give your face a fuller and more youthful appearance. Be sure to have it done with an experienced injector to optimize your results. Best regards, Dr. Mehta

You should consider seeing a rhinoplasty specialist in your area. I’ve done a steroid injection in a patient who had a rhinoplasty 40 years ago (!) in Iran, and she noticed a nice improvement in her tip definition. She was able to avoid having a revision rhinoplasty. I do them routinely in patients well past the one year mark to reduce scar tissue and swelling. That would be a good first step followed by an assessment to see if you need a revision to reshape your tip in a more aesthetically appealing way. Kind regards, Dr. Mehta

An in-person exam would be helpful but it’s certainly possible that you may have some scar tissue under the skin that could respond very well to a steroid injection. I use Kenalog plus 5-FU for this. If your surgeon is unresponsive, you could seek a 2nd opinion. Kind regards, Dr. Mehta

Sorry to hear about your negative outcome from your rhinoplasties. It is absolutely possible to remove the cartilage fragments from your bridge and replace them with tiny diced cartilage pieces that are glued together with Tisseel. If you check out our Instagram feed, I recently posted this technique in a video and showed a case similar to yours. By dicing the cartilage finely and gluing it together, the bridge can be augmented in a smooth, natural, and predictable way. Rib, septal, and ear cartilage are all options. In fact, some of the cartilage that’s already there could be diced more finely and included. From the photo, it appears your tip could also be made more refined. An in-person or virtual consultation would be a good first step! Kind regards, Dr. Mehta

Thanks for the question! I remove scar tissue and thin the skin envelope very frequently in both primary and revision rhinoplasty. This must be done very carefully to preserve the blood supply to the skin. I would have to examine you in person to let you know if you are a candidate... Sometimes if the cartilages were made too small inside the nose, there is empty space between the cartilage and the body fills this space with scar tissue. Often making a nose more defined in thicker skin patients involves actually making the cartilage stronger and taller, so it can push into the skin envelope from underneath. Other nonsurgical options include more aggressive steroid injections with 5-FU before and after surgery. Accutane therapy can also help. We are updating our website, but our IG has all the latest before/afters. Feel free to reach out anytime if you have any questions! Kind regards, Dr. Mehta

Yes, nonsurgical rhinoplasty (filler in the nose) can be an excellent option for raising a bridge that was over-reduced during rhinoplasty. I use Restylane Lyft primarily for this indication. The filler is reversible if needed, and the results should last 1-2 years or more. In the future, surgical correction with diced cartilage could be an option, or you could do the filler periodically. Best regards, Dr. Mehta