"Pig nose" correction - Revision possibilities?

In any case of revision rhinoplasty, an examination is necessary to get a sense of what was done during your last surgery. De-rotating/ lengthening a nose is far more difficult than the opposite

Hello and thank you for your question.

First off, it's important to recognize that complications happen to ALL surgeons, and any surgeon that does not have complications or any suboptimal results is either not operating enough or lying.

With that said, although an exam in person is ideal, from your photographs alone, I agree that your tip is over-rotated ("sitting on your bridge") and the "scratching" sensation is likely due to the cartilage in your constructed tip complex rubbing on the septal cartilage when you gesture ("talk/chew/smile"). This can happen with tip deprojection (aka making your nose less "pointy") -- your operative report mentions a lateral crural steal and medial crural overlap, which is a method of tip deprojection. Although this is very technical, sometimes when you deproject the tip of your nose, the tip can also over-rotate ("tip sits on your bridge"). The big picture solution now is to DE-rotate the tip of your nose. This is a very tricky maneuver. The surgery I perform to achieve this involves excision of any soft tissue scarring, in addition to placement of extended spreader grafts and extended alar contour grafts. I would also place a mastoid fascia tip graft between the reconstructed tip complex and your skin to (1) reduce cartilage prominence (tenting up of the nasal tip skin by cartilage) and (2) to also create a feminine tip-defining point (subtle natural upturn).

Long story short -- I would suggest a revision rhinoplasty and I am confident you can get the result you wanted -- the tip can de-rotate and not sit on the bridge, and your cartilages will no longer scratch together when you talk, chew, or smile.

Due to your prior rhinoplasty, the cartilage in your septum was likely harvested and so you will likely require MTF (Musculoskeletal Transplant Foundation) aka cadaver cartilage to perform this revision rhinoplasty. Also note that if your septum is deviated and you have breathing difficulty, a revision septoplasty may benefit you as well, which can be covered by health insurance.

If you are at least 1 year out from your rhinoplasty, the skin has likely healed and is healthy enough to undergo a surgical intervention.

The next step for you is to pursue the right aesthetic plastic surgeon for your revision rhinoplasty. In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon