Bigger bump after rasping 1 year after rhinoplasty (3+ months PO), is it swelling/scar tissue? Will it go away? (Photos)

I would just recommend a rhinoplasty. Most of the "bump" is actually cartilage. The nasal bones merely have a "bony cap" extension over the most prominent part of the cartilage. Usually rasping only removes the bony cap and other measures are needed to fully address the dorsal convexity.

Hello and thank you for your question. Although an exam in person is ideal, from your photographs alone it appears that you do indeed have a residual hump after your second rhinoplasty.

This may be due to a number of reasons:
(1) Inadequate rasping of the bony hump.
(2) Inadequate resection of the cartilaginous portion of the hump.
(3) Residual scarring post resection.

Essentially, the hump has a bone and cartilage component to it -- bone and cartlage overlap along the top third of the bridge of the nose, called the keystone. To excise the hump, both the bone and cartilage have to be resected. The bone can be rasped (shaved) but the cartilage has to be resected (cut) directly, and not shaved. If only rasping was done at your second surgery, there's a possibility that the cartilaginous portion was not addressed. Was your cartilage (specifically the upper lateral cartilages) excised during your second surgery?

Another point of concern is that any residual hump reduction is ideally treated with osteotomies (bone breaks) to narrow the nose, otherwise an "open roof" deformity may be created where the dorsum (bridge) of your nose is flattened and widened. Were osteotomies performed in your second surgery to narrow the top third (bony portion) of your nose?

Some possible options moving forward include steroid injections, although if there's no significant improvement at 3 months postop, steroids are unlikely to significantly improve the hump. My recommendation would be to wait approximately 12-18 months for the swelling to resolve and perform a formal revision rhinoplasty at that time.

It's important to recognize that complications happen after surgery, and EVERY surgeon has complications.

Please discuss these options with your surgeon.

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

Hello and thank you for your question. I don’t recommend having rasping performed under local anesthesia. This will usually make the nose look better for 1-2 months and then it will actually get much worse long-term afterwards, with contour irregularities developing. This is because the skin of the dorsum is extremely thin. A much better approach is to do a formal revision with rasping and placement of a dorsal onlay fascial graft to help smooth the dorsum. Here is some general advice when considering a surgeon for a revision.

I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up. Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag. If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, that can also be a red flag. Long-term results are much more meaningful than on table results or 1 week post-op results. .

Best wishes and good luck.

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

Hi. From these photos, it seems that the increased size of the bump is a relative increase rather than the bump itself increasing in size. So it looks bigger because the part above it looks lower. The radix (very top of the nose, btwn the eyes) appears deeper in the after 3mo PO photo. You might have still had some swelling or tissue tenting that disguised some of the bump in your 1 yr post op photo, but it decreased after the rasping, revealing more of the bump. When you compare the depth of the radix to your eye brows and eyelashes in these side photos, you can see that it is deeper on the 3mo post op pic. You can compare the bump itself to the lower part of the nose (which has not changed) and it is relatively the same. Although it is hard to tell from this photo, there may still be some minor swelling at the bump itself that is contributing to a small part of this, but this doesn't seem to be the main cause. A nasal bump is made from bone and cartilage. Bone can be rasped, but you cannot reduce the parts made from cartilage this way. Cartilage is reduced with either scalpels or scissors. If you run your finger down the nose from top to bottom, you get get a better sense of the actual structure below the skin (and swelling).I would avoid steroid injections in this area as the skin tends to be very thin there and can result in unwanted indentations. You can gently massage the area and give it some more time (6mo - 1yr) for any swelling to fully resolve and see your final result, before deciding if you want to make any changes.

In my experience it is best to wait a full 6-9 months to allow for nearly all the swelling in the dorsum to subside before making decisions on next steps. That said, it does appear that the rasping may have been too aggressive superior to the residual bump, leaving the residual bump even more pronounced.
Give it time and don't inject anything into your nose for now. You don't want to compromise the quality of the overlying skin or jeopardize your ability to have a revision procedure if necessary.

From the photographs presented, most of your hump is cartilage, not bone. Rasping only accomplishes removing bony humps. A closed rhinoplasty procedure can accomplish shaving down the entire bump, which is composed of both bone and cartilage, and you will also need osteotomies placed in the nasal bones to close the open roof created from the hump removal itself.