Vito C. Quatela, MD

It is difficult to tell without a face forward view and a view of the base of your nose, however, it appears you have some soft tissue fullness just above the tip of your nose. The cartilage and bone do not get larger after surgery, though they can shift as they heal. An experienced surgeon can address the scar formation near the nasal tip with small procedures or revisions. You would be best served seeking a consultation with a board certified facial plastic surgeon.

Caution should be used when using filler in the nose. Achieving a smoother and contoured tip would be challenging for you using filler alone. It appears there are issues with the cartilage in the tip of your nose that are best addressed with revision rhinoplasty in the hands of someone well versed with the procedure. You would be best served by a consultation with a board certified facial plastic surgeon to discuss your options.

Narrowing the width of the nose and refining the nasal tip are best accomplished with rhinoplasty. Injectables can be used to correct slight asymmetries in the nose. You would be best served by discussing your goals with a board certified facial plastic surgeon to decide which approach will be most appropriate for you.

It appears that you have some narrowing of the nostrils and prominent cartilage that are contributing to the bumps you see. It would have been helpful to see more views of your nose in the photos. It is possible to have a revision rhinoplasty to make alterations to the tip, open and shape the nostrils and reduce the appearance of the cartilage contributing to the bumps. Revision rhinoplasty is a challenging procedure. You should consult with a board certified facial plastic surgeon to further discuss your goals if you would like to pursue another surgery.

There are surgical and non-surgical options to reduce excess soft tissue under the jaw and define the jawline. The non-surgical options you have identified above may help you achieve a more refined jawline. It is important to note that multiple sessions are required and there can be swelling and discomfort with non-invasive options. Surgery to address the neck and jawline through a combination of liposuction and tightening the tissue of the neck is another option that requires a one-time procedure with associated downtime, but a durable and predictable effect. A full consultation with a board certified facial plastic surgeon would be the best next step to discuss your treatment options.

Without images to assess your nose, it is difficult to provide a specific answer. Unfortunately, it is not possible just to “push” the upper lateral cartilages back up. These cartilages join with the nasal bones and the septum to create a nasal airway and shape. Since you have difficulty breathing with possible internal nasal valve collapse, then spreader grafts or auto-spreader grafts are likely needed. A complete examination of your nose by a facial plastic surgeon specializing in revision rhinoplasty is necessary to determine what anatomical issues are contributing to your airway obstruction and how they should be addressed. It is important to remember that the different cartilaginous and bony parts of the nose interplay with each other and cannot be taken as separate entities. If you change one component, the others need to be addressed to create a functional airway as well as a good aesthetic outcome.

The lines in the lower face around the mouth would best be addressed by a hyaluronic acid filler, such as Juvederm. The nasolabial folds, marionette lines and the jawline around the jowls can all be improved with this filler. Sculptra is better for volume loss in the midface and temples, which you do not appear to have. A consultation and examination by a facial plastic surgeon will help determine the best injectable treatment for you.

Even with the images you provided, it is difficult to determine why you have a bump now that you did not before. An examination by a facial plastic surgeon specializing in rhinoplasty would help determine if you have developed a calcification along the nasal bones, if you have some skin thickening/scar tissue formation, or if the cartilage has shifted. If the problem is skin thickening, injections with steroids and taping will help. A dorsal calcification tends to decrease in size over time until about 1 year after surgery. If it does not improve, a minor rasping (shaving) procedure will provide improvement. If cartilage has shifted, a revision surgery may be required after another 6 months. Surgical intervention prior to a year after the first surgery is not recommended since you are still healing and forming scar tissue.

From the limited images provided, it appears that the caudal septum (the part closest to the outside) is still deviated. This is contributing to the asymmetry of the nostrils. In addition, there may be a component of external valve collapse (which is seen if you have collapse of the nostril with inspiration). If there is external valve collapse, a more extensive revision would be required to add support to the lower lateral cartilages to prevent collapse and improve breathing. A complete examination by a facial plastic surgeon would help identify the anatomical issues you have and create the surgical plan most appropriate for you.

Botox used for migraines targets the forehead where the crease between the eyes is as well as other areas. Therefore, the glabellar lines will be treated. If you have a deep wrinkle that is visible at rest, then Botox to the glabella will not completely eradicate the wrinkle. You may benefit from a filler like Juvederm to the wrinkle in order to diminish its presence at rest. After a thorough examination by a facial plastic surgeon, the treatment plan most appropriate for you can be recommended.