Why does nasal tip right after case removal look so much smaller than 1 year later?

Question

I'm wondering why does the nose look so much more defined and small at the nasal tip right after cast and tape removal but ends up looking a LOT bigger after one year? It could not be just that the tapes compress any edema from the nasal tip because even if I tape my nose now overnight and remove it, it does not look much different from my regular nose directly after removal. Is this SMAS or dermal thickening? If scar tissue, what tissue layer is this in?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The final results take at least 1.5 years for the swelling to fully resolve. This can require lots of patience and waiting.  Steroid injections performed by your surgeon can be extremely helpful. I usually start steroid injections around 1 to 2 months after surgery and continue as needed. The SMAS is a term we use in facelifts but not in rhinoplasty.    It is possible to debulk soft tissue in the nasal tip during surgery.  I recommend that you maintain close follow up with your surgeon who can evaluate you in person.

Best wishes and good luck.

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

Steven M. Denenberg, MD · Answer

When I tape a nose at the end of surgery, I put the tape around the tip very strongly, and that can participate in keeping the tip swelling low. But that's different from taping the nose after the splint is removed. I don't think taping after spint removal does anything at all.

The question now is why is your tip too wide. Actually, the best case would be that the swelling isn't unusual (it's unusual to have a rather noticeable amount of swelling after a year) or that there is a thicker than average scar layer under the skin -- the best case would be that the tip cartilages are still in a position to make the tip look wide. That's best, because it means that a revision can make improvements. If the problem is skin thickness or scar tissue, it's much harder to get improvements, in fact, another operation may not even be advisable.

What does your surgeon say? If he is an expert, he would be able to examine your nose and tell you. He might say that the techniques he used to narrow your tip didn't work as well as he thought they would, but there are other, more stronger techniques that have a high likelihood of getting you where you want to go. He would look at his operation notes and photographs and make that determination, along with feeling your nose to see where the cartilages are positioned right now, regardless of where he left them at the end of surgery. If he placed your cartilages in a great position during surgery, and he knew it would work, then when he feels your nose he'll be able to tell that, for example, you might have an unusual collection of scar tissue. I'd let him make that determination and go from there.

Eric M. Joseph, MD · Answer

If your nasal tip appearance is wider 1 year after surgery then at the time of your reveal, this is either due to scar tissue or excessive cartilage remaining in your nasal tip. Please consider reconsulting with your rhinoplasty specialist to operate it on you. Thank you for your question. Sincerely, Dr Joseph

Why does nasal tip right after case removal look so much smaller than 1 year later?

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Why does nasal tip right after case removal look so much smaller than 1 year later?

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