Advice Needed on Revision Rhinoplasty After Cephalic Trim on Boxy Tip? (photo)

I had rhinoplasty 2yrs ago to refine my boxy tip(only cephalic trim with a good amount of cartilage left,8mm as told).I have med thickness skin btw. However, my nose hasn't changed at all.The tip is still boxy and I'm considering a revision.This time I would also like to reduce my dorsal bump and address tip rotation if needed.My goal is to preserve the overall "look" of my nose but make the tip more defined and have a nicer profile. What will the surgery entail and will I need cartilage grafts?

Doctor Answers 6

Revision rhinoplasty

You obviously had a closed rhinoplasty but it is unclear exactly what was done at surgery. A cephalic trim alone will not correct a boxy tip. You also need to place shaping sutures to realign and reshape the cartilages. You say this time you want to address the dorsal bump. That implies that you restricted your previous surgeon from performing an entire rhinoplasty. You can do the procedure piecemeal but that costs more and usually leaves you with a less desirable result especially if you go from surgeon to surgeon.

You should go back to your original surgeon to complete the surgery if did not allow him/her to do the full surgery the first time. If you want a second opinion or decide to change surgeons you need to see another surgeon face to face and bring the records, operative reports and preop photos of the first surgeon with you to the consultation. Just using this forum will not clear up this situation or enable you to clear it up.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Revision rhinoplasty for the dorsal hump and tip refinement.

Revision rhinoplasty for the dorsal hump and tip refinement can be done with improvement of your nose. I would need to see better photographs to give you specific answers to your questions. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Revision of Nasal Tip 2 Years Post-op

After waiting 2 years you can clearly evaluate the results of your previous rhinoplasty. Your tip can be narrowed and refined, the rotation changed if necessary, and the hump removed. In the frontal view it appears that you have an hour glass appearance with narrowing of the mid-portion of your nose which can be improved with cartilage spreader grafts.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

With adequate tip cartilage a graft is not required for rhinoplasty.

The picture demonstrates adequate tip cartilage both in volume and strength. I would think that a revision that reshapes those cartilages will yield a good result without any grafting. Make certain that your surgeon is quite familiar with rhinoplasty is revisional procedures are much harder than primary.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Advice Needed on Revision Rhinoplasty After Cephalic Trim on Boxy Tip?

     Your goals can be achieved with a closed rhinoplasty that refines the tip and gives a modest dorsal hump reduction.  I would not use cartilage grafts based upon the pictures.  Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasties each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Revision rhinoplasty

You certainly look like you could benefit from revision rhinoplasty to improve the appearance of the dorsum and tip.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 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.