Tip of nose too over rotated? Dent? Natural looking? (Photo)

Question

Hello! Had a rhinoplasty done 6 months ago. SEG placed, hump reduction, tip rotation. I overall am not 100% satisfied. I wanted a straight, not sloped bridge, neutral tip. I feel like my tip is overaly rotated, sloped bridge, excess nostril show, and I feel like it just does not look natural. Would like some thoughts.

Andrew Miller, MD · Answer

Based on your photos, if you feel like your nose is too slopy, you can have a graft placed to make the bridges appear more straight. It is important to see a rhinoplasty expert who can do computer imaging to help determine a good plan before the surgery.

Lexie Wang, MD · Answer

Your nose looks pretty good- I think many patients would be very happy with a change like that. It might not be necessarily what YOU want, though, and only YOU can determine that. Objectively speaking, I would say that you have a very nice outcome now; however, I do agree that ome may find that this is too rotated/sloped/unnatural. It is a very typical "rhinoplasty" nose. Perhaps that was not what you were looking for in your consultation.

Eric M. Joseph, MD · Answer

The appearance of your nose will continue to change over the next six months, while the remainder of your swelling dissipates, especially at the base of your nose where the SEG lives. I'm not sure if your nasal tip is terribly over rotated. You appear to have a bit of a bulge where your columella meets your upper lip. This could be the SEG, or simply swelling. I agree that your upper bridge is a bit too low, and that there appears to be some asymmetrical nostril show. Before considering revision rhinoplasty surgery, please check to see whether or not you are a candidate for a permanent nonsurgical nose job. In our experience, microdroplets Silikon 1000 injections may be helpful for raising a nasal bridge appearance and for lowering nostril margins on front view, permanently, after previous surgery. Revision rhinoplasty surgery might be more complicated with a dorsal onlay graft, and adjusting the position of your tip with the SEG, perhaps for some tip lowering. I hope this helps, and I wish you well moving forward. Sincerely, Dr. Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a revision rhinoplasty. Maneuvers for your surgery would include nasal tip derotation with extended spreader grafts, tip refinement, nasal tip deprojection, among other maneuvers. 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

Best wishes and good luck.

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

William Portuese, MD · Answer

A revision rhinoplasty can be contemplated in another six months when you're one year postop to allow full healing to occur before undergoing another procedure. To build up your bridge is going to require cartilage grafts so it's important to know how much cartilage is left over on the inside of your nose for grafting purposes. A copy of the operative report would be helpful for your revision rhinoplasty surgeon. In addition, you have a hanging and overrotated columella which needs to be de-rotated as well and reduce the amount of tissue between your nostrils.

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