Revision rhino looks bad. Over-rotated angular infratip break and possibly pinched Depressed and disappointed. What can be done?

Question

I feel so bad that i got a revision (6 months after primary) , Its been only 2 weeks and I feel it looks almost the same, with same problems I got after the 1º surgery. I hate how over-rotated it is, I wanted a 90º nose, not this super elevated unnatural angle. Also i'm terrified to see that it looks pinched now, esp- from the below angle. The doct put a graft in the tip to make it bigger but it didnt work like that and another one in the collumella but its still way too straight and angular

Suleyman Tas, MD, FEBOPRAS · Answer

Hello, thank you for your question, provided information and photos. Based on them, firstly it is important to complete healing phase and before completing it any kind of intervention should not be performed. Your tip will droop as your nose heals, and you have edema and swelling as you are healing tip is the last area to heal. You need to wait and complete your healing phase and then if your final outcome is not satisfying after having a detailed physical examination you can undergo a revision rhinoplasty to improve your nose for desired and most suitable look. Best Regards,

John Bitner, MD · Answer

Thank you for sending excellent photos.  This really helps when trying to offer an opinion on others work.  Obviously, you are very early on in the recovery process.  So, it is difficult to make complete decisions.  However, there are several areas of significant concern.  First, the over-rotated appearance.  While it is true that the tip may drop a little over time as your nose heals, it is very over-rotated and it will never make it to 90 degrees (generally I prefer a slight up turn of 95-105 degrees).  You are at probably 130 degrees or more.  The second is your comment about it having a pinched look.  Typically the tip of your nose is still swollen and the very last area to heal.  So, if you feel it is already too pinched, it won't likely improve.  Tip de-rotation is one of the most challenging parts of a rhinoplasty operation.  Please go to our link below for a whole number of de-rotation operations in our before-and-after gallery.

Alejandro Nogueira, MD · Answer

In spite it is a too early assessment I notice a few issues and also wish to answer your concerns in the following items:-There is an unfinished dorsal hump that, still after 2 rhinoplasties, is pending full shaving to achieve a straight profile.-I don't know if this is a congenital issue or a consequence of the rhinoplasties suffered, but you show (and very clearly) a short septum, which causes the upturned nose and the sunken columella; this was not fixed and now is a pending maneuver: septal lengthening or full caudal septum restoration.-I agree the nose is pinched, evident, and the alar rims are severely retracted, this is due to over resection and/or untreated malpositioning and/or untreated weakness of the lateral cruras of the alar cartilages; batten grafting or full lateral crura replacement are required here.-There are other issues: poorly supported tip that may need reprojection, needless to say with derotation so that the nasolabial angle is zero or no more than 5-10º from the horizontal plane, etc.Seek the advice and hands of a serious professional who offers to you a time-consuming and expensive procedure; stay far from minimally invassive snake-charming procedures, synthetic implants, fillers, wrapped diced cartilage, etc.
Difficulty 7 out of 10 in revision rhinoplasties, surgical time about 5 hours (in expert hands, could be even longer).
See the link below to find few cases of my own practice very similar to yours which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted.
If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views, also from underneath.
Feel free to request any additional information from me.

Jesse E. Smith, MD, FACS · Answer

Realizing that you are only two weeks out from your second surgery, it would be difficult to say exactly how your nose will eventually settle out. It is very common for the nose to over-rotate at the tip while swollen. As swelling along the bridge of the nose settles, the tip tends to rotate downward. It's best that  you give this some time prior to making judgement about the nose. I would at least give the nose 1 year to drive all swelling out prior to considering any further rhinoplasty.

Revision rhino looks bad. Over-rotated angular infratip break and possibly pinched Depressed and disappointed. What can be done?

Answers (4)

Answer: Revised Rhinoplasty

Answer: Revised Rhinoplasty

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Everything you need to know about Revision Rhinoplasty

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Revision rhino looks bad. Over-rotated angular infratip break and possibly pinched Depressed and disappointed. What can be done?

Answers (4)

Answer: Revised Rhinoplasty

Answer: Revised Rhinoplasty

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.