How can my nose bridge and bulbous tip improve now?

You will need an open rhinoplasty/septoplasty. Cartilage would be harvested to correct your dorsum super tip deformity. Also, your nose is leaning towards one side and the tip is asymmetrical.

Best Wishes,

Gary Horndeski, M.D.

Hello, After discussing issues honestly and openly with your surgeon, if you are not getting the response that you want, the next best step is to have consultations for revision surgery. In this process it is very important to have at least 2 or more consultatios with true rhinoplasty surgeons that do high quality work, as well as experience with revisions. You will be able to compare their assessments and surgical advice.Ask for potential reasoning behind the issues you are seeing and how those issues might be corrected. We do not always know for sure, but a good surgeon will have some ideas as to what they might find and how they would address it. You can then compare those answers. In your case, from the photos, it seems the 3 quarter "bump" is a step off from bone to cartilage, possibly from a nasal bone that needs to be shaved and/or an upper lateral cartilage that needs to be supported. The tip fullness and nostril retraction seem to be from lower lateral cartilages that are convex in shape and "cephalically malpositioned" (oriented upward). This leads to fullness above the tip while lacking support at the area of nostril retraction. The supratip dip is an issue of relationship between septum and tip heights / projection. An important concept that I frequently discuss with similar revision patients is that such cases are mostly about the subtlies of shape and orientation.There's more to unpack here but those are really the major things that can be seen from the photos. I hope this helps you have good and productive discussions during your consultations. Good luck!

After this long, there should be very little swelling left in the nose, so the problems that you see are more likely related to the size and position of the cartilages currently remaining in your nose. It would likely take a revision to get things much closer to where you wanted them. Especially after this long, and after previous shots, more steroids are just extremely unlikely to do anything good, and might cause trouble. I can see various features in the photos that you might want to improve or correct in a revision.

Planning for a revision in a nose like yours would involve evaluation of detailed morphs, so you and the surgeon can know what's important to you, the surgeon can communicate how much improvement is realistic, and you can make sure he understands your goals thoroughly. We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Thank you for your question. You are an excellent candidate for rhinoplasty. I think it is one of the most beautifying surgeries that we do as plastic surgeons. A large portion of my practice is dedicated to rhinoplasty surgery. In your case, a revision rhinoplasty should be able to produce an excellent aesthetic result. It is important to only see plastic surgeons with extensive experience in rhinoplasty, ie perform at least 6 per month and have performed hundreds of cases. Also, critically evaluate on-line galleries to see if their art form resonates with yours. Rhinoplasty is definitely a grey haired plastic surgeon's sport. You should be able to have an excellent result. Best wishes to you

If you decide to get a second opinion from another reputable rhinoplasty specialist, it may be helpful to bring with you your preoperative photos and a copy of your operative report. At this point, I agree that continued steroid injections may not be a good idea. Wishing you well. Sincerely, Dr Joseph

Probably you still have a deviated septum - the axis of you nose is deviated to the right (your right); the bulbous tip is there + an isolated tip (we call that the bright tip surrounded by shadows). You would benefit a procedure where your bridge is moved to the left en bloc (at least the bony part) and structure the rest of the nose (semi preservation dorsum rhinoplasty); the tip must be structured; the Lower Lateral Cartilages must be put in the correct position (reconstruct your resting angle) and the retracted alae must be corrected

Some tissue changes after steroid shots are temporary. It takes about 3 months after steroid injection to see the final result. Also, it takes at least 1 year to see the final result after a rhinoplasty. Once the shape stabilizes, then you could look into treatment. For the alar rim shape, revision surgery is the only option. For the nasal tip/supratip and the dorsal bridge, filler or revision surgery could be used to fine tune the shape. The most common surgical technique to smooth a bridge during revision would be a graft. The supratip during smile would need to be evaluated in person. In certain cases, dividing the muscle pull on the nasal tip is possible.