Am I a Good Candidate for Revision Rhinoplasty?

I had rhino/septo-plasty over 1.5 years ago, and am unhappy with the results: (1) Pointy/Pinched tip of the nose that is droopy, especially when smiling--near hook appearance. The pic shown is right profile WITHOUT smiling. The tip droops much further down and looks awful when I smile. (2) Hanging and scarred columella. Prominent scar line. Skin is bulgy and hangs lower after scar line. I can email more pictures directly. Any opinions on corrective measures very much appreciated.

Doctor Answers 4

Candidate for Revision Rhinoplasty

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You are a candidate for rhinoplasty revision. It is difficult to make specific recommendations because animation makes your nose look worse. Ideally, you need to be examined by an experienced surgeon - another alternative is to submit additional pictures.

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Revision for droopy tip

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There are options, through cartilage grafting and establishing tip support, to keep your nose from drooping as much and to correct a pointy and pinched tip

Revision rhinoplasty should be carefully considered

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Revision rhinoplasty is not something to undergo lightly. The revision rhinoplasty procedure involves removal of any residual dorsal hump that is present which can be composed of both bone and cartilage. The reason the tip droops upon animation is due to a ligament which connects the tip of the nose to the orbicularis oris muscle. The smiling muscle when contracted will pull the tip down. To prevent this from occurring the ligament is divided at the basal spine of the nose and this stops the depressor septi ligament action. This surgery can all be done through a closed rhinoplasty technique without an open rhinoplasty, thus avoiding a scar to the columella. Columellar show is reduced by trimming both the membranous and cartilaginous septum.  

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Revision rhinoplasty can help downturned noses

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As the sub-specialty of revision Rhinoplasty matures, along with the specialists in revision surgery, we are getting better at recognizing the reasons why people need revision surgery. When the tip of the nose still points down after rhinoplasty and even worse with smiling it is often due to the tip cartilages having been at a higher angle than average before the first surgery. This is called cephalic oriented lateral crura. What that means is that if the upper part of the tip cartilages are angled too high before surgery, unless compensated for the tip of the nose will continue to appear to plunge after.

Treatment for tips that still plunge is by either supporting the nostrils with grafts, relocating the tip cartilages lower down so it helps thrust the tip upward or both. I suggest you seek a specialist in revision rhinoplasty to get a personal evaluation.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 134 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.