Would a tertiary rhinoplasty build up the top of my bridge? (photos)

Hello and thank you for your question. Based on your photographs, you may benefit from dorsal augmentation with diced cartilage wrapped in fascia. Tip refinement and support can also be performed at the same time. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

It is likely that swelling has gone away from the top of the nose and gotten worse or turned to scar towards the bottom. This is called a "pollybeak" and can be addressed by either raising the top of the bridge or doing things to lower the bottom and reduce swelling and scarring.

A tertiary rhinoplasty could be considered, however I typically recommend patients wait for 2 years post-op after there initial revision due to the degree of scarring that occurs and to avoid vascular issues with the overlying tissues. Final results of a revision rhinoplasty take considerably longer than after a primary surgery and you should delay considering revision until a final result is reached to fully assess what would need to be address in a revision. Currently, on profile, you have what is referred to as a polybeak deformity which could can be caused by either excess volume in the supratip area, a lack of tip projection and support, or both. A revision rhinoplasty could remove excess grafted material in the dorsum if needed and provide adequate support for the tip using a septal extension graft to address your concerns.
Sean M Fisher MD