Looking into a revision rhinoplasty to make nose smaller & fix tip - most revision result in wider nose? (Photos)

Question

I had my rhinoplasty in 2015. I'm 32 and feel it's time to circle back to fixing my nose. My desire would be to have my nose a bit smaller and fix the tip. My concern is that most revisions I see result in a wider nose.

Jonathan Kulbersh, MD · Answer

Thank you for submitting your question and photos. The goal of rhinoplasty is to form an individualized plan to bring the patient’s nose into balance with the rest of your facial features. During a comprehensive exam, your entire facial structure will be considered to achieve this balance. 
A revision rhinoplasty procedure can address the tip and create a smaller, more narrow appearance while improving overall symmetry. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon.

Andrew Miller, MD · Answer

Based on your photos, you are a good candidate for revision rhinoplasty. Revision rhinoplasty can cause more swelling, but it's not usually as simple as "they always make the nose wider". Many patients get revision due to pinching of the tip. When this is relieved during revision, the tip will look a little wider, but more natural due to fact that it's not pinched anymore. Be sure to see a rhinoplasty expert for consultation.

Marc Polacco, MD · Answer

Thank you for your question. You're correct that revisions often widen the nose from prior, and the reason for this is that often there is too much narrowing and pinching, which results in breathing issues. In your case, the septum is deviated and the tip twisted, which most likely will require cartilage grafting to address. So really it's a tradeoff of having a slightly larger nose with a revision versus how it appears right now. I'd make sure you discussed that in depth with your surgeon, and I wish you all the best.
-Dr. P

Gianfranco Frojo, MD · Answer

Your revision would require using cartilage grafts to help straighten and support the nose. This would require some widening of the nose by definition, especially where you have the significant curvature. I would recommend seeing a board certified or board eligible plastic surgeon with aesthetic surgery training/experience who can perform a full exam and provide safe recommendations.

Gurkan Kayabasoglu, MD · Answer

Hello. Your nose has a serious cartilage asymmetry and overprojection problem. Your skin is thin, so your revision should be done very meticulously. But this time you should find a very good surgeon. I’m the only triple board-certified facial plastic surgeon all around Europe. I’m just focused on this issue. I am a doctor who goes to almost every country in the world and explains my techniques to important doctors with the seminar invitations I receive, so I am definitely the only doctor who can perform your operation very comfortably and successfully. You can get more detailed information about me, ask all questions about your case and sending your photos to my assistants at the number on my profile (+90 539 204 40 90). You can also book an online consultation and discuss your problems with me. With all respect.

Philip S. Schoenfeld, MD, FACS · Answer

Revision rhinoplasty comes in all flavors.  Not all revision rhinoplasties result in a larger or wider nose.  The nose that the revision rhinoplasty specialist is given to start with will dictate what needs to happen with the nose in terms of size once the nose is revised.  In your particular case, you have a crooked lower third of the nose due to weak or over resected cartilages during your primary rhinoplasty.  If a revision surgery were to be performed on your nose, the surgeon will absolutely need to add cartilage grafts in order to strengthen the nasal tip. When performed correctly, the nose will appear proportionate, not wide.

Thomas Trevisani, MD · Answer

Based on your photos- it appears that you would benefit from a Revision Rhinoplasty preferably performed through closed technique. In the right, experienced hands- you can expect improvements and a better looking nose. I suggest that you seek an experienced Board Certified PS with a wide gallery of before+after photos

Jeffrey Lisiecki, MD · Answer

Yes, revisions often do widen the nose, but they don't necessarily need to. This is for a couple of reasons. One is scar tissue and swelling, which are worse in a revision rhinoplasty, which can be mitigated with a careful regimen of steroid injections and taping. The other is that we often use spreader grafts or flaps in revision rhinoplasty--sometimes they are necessary, but not always, and when they can be avoided they should be avoided for precisely the reason you notice--they widen the nose. See a rhinoplasty surgeon and discuss your concerns with them; they will help you make a decision.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Revision rhinoplasty doesn't necessarily mean a wider nose. But, in your case, the nasal tip is very pinched and small with some crookedness. In order to make the nose in a better position, structure rhinoplasty is ideal. This uses cartilage from your nose (or rib) to provide strong grafts. This helps keep the nose in position. If done well, the grafts can be contoured accordingly to create a nice result. Will the width increase? Yes, but into better aesthetic proportions and shouldn't look unsightly. Hope this helps you!

William Portuese, MD · Answer

The photographs demonstrate pinched nasal tip cartilages,  collapse of the right upper lateral cartilage and hanging columella. All of these issues can be addressed with a revision rhinoplasty. It's very important to know how much cartilage is left over on the inside of the nose for grafting purposes. A copy of the previous operative report would be helpful. Placement of cartilage grafts in the nasal tip will offer more support and structural integrity and make it look more symmetrical, but it will be slightly wider.

Looking into a revision rhinoplasty to make nose smaller & fix tip - most revision result in wider nose? (Photos)

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