14 Months Post Rhinoplasty: Still Swelling or Did I Get a Bad Nose?

Hi there.

Your rhinoplasty has been competently performed without doubt, and I'm not sure your initial swelling was significantly more than average.

Your preop shows a long, thin, overprojecting nose and you have an above average facial appearance.  It's understandable why you would have sought rhinoplasty surgery.

On your postops at 14 months there's a lot to like about the result whilst being able to explain your concerns.  You can see from your side and front views that the tip has been deprojected and rotated up as it should be.  Your front view looks fine and the bridge has been nicely done.

The reason for the appearance you have is that your tip and columella are full, with I suspect medial and intermediate crura which are too long. resulting in a heavy looking bottom half of the tip and a bowed columella.  This creates an impression of a nose that's too long and an upper lip thats too short.

The solution is a tip revision.  I don't think there is a non surgical option which will help.  The bridge height and shape looks good, and the lateral alae are rotated into a good position.  The tip cartilages are too long however and what's happened when your nose tip was deprojected and upward rotated an apparent down ward rotation of the central tip has occurred  because of the excessive length of the lower lateral cartilage. ( I have caused this problem myself).

At operation through an open approach, the lateral crura of the lower lateral cartilages need to be shortened or overlapped, and the medial crura need to be shortened ( or the footplates resected which is my preferred way of doing that).

That's all that needs to be done and I think your rhinoplasty will be excellent.

As a surgeon, we do not want to shorten the tip supporting cartilages unless we have to, so we will tend to leave them if we are not sure or if we think we have deprojected enough just through the rotation and repositioning.  Its safer to do later if needed, than to overdo at the initial procedure. I stress that I think your rhinoplasty has been well done and that you had a difficult nose initially, it's hard to get that tip short and deprojected enough.  No damage has been done.

Correcting the problem will take around an hour of operative time, and less of a recovery than the initial rhinoplasty, but not no recovery.

I hope this makes sense and helps you.

 

Good luck.

I read your concerns and reviewed your photos:

You appear to have achieved natural-looking profile-hump reduction and tip rotation. I'm not sure what you mean by the "relative shapeless" appearance of your nose. Your nose does not appear to be too large. In my opinion, your appearance has improved after your Rhinoplasty.

If you could be more specific as to what is bothering you about your nose, I would be happy to share my thoughts with you.

I hope this is helpful for you.

Regards from NJ.

You definitely have some nice changes and shape to your nose. Everyone's aesthetic is diffferent and individual. You need to do some computer imaging to try and better articulate what concerns you and see if you really would like it if further changed. You do have some alar retraction and tip underprojection but whether you would like your nose if these are changed is still unknown.