Revision Rhinoplasty Concerns – Rib Cartilage Harvest, Nasal Tip Correction, and Skin Envelope Limitations (photo)

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 appears slightly over-rotated and has some supratip fullness. I would recommend (1) extended spreader grafts with MTF costal cartilage to de-rotate your tip and bring it out to length and (2) a hybrid graft with mastoid fascia and diced cartilage to augment your dorsum. 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, and reduce the cost of the procedure.

As you are 7 years out from your rhinoplasty, the skin has likely healed and is pliable enough to handle the surgical changes -- no tissue expansion is necessary; also note skin expansion on the nose is not a common procedure...

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, IN PERSON, 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. I also think a key component of your consultation is to establish a good connection with your plastic surgeon. This is difficulty to do without seeing your surgeon in the office, in person. 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 MALE 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. Based on your photographs, you may benefit from a revision rhinoplasty. Tip derotation can be performed by releasing all scar tissue, followed by placement of extended spreader grafts. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

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

Based on your photos, your nasal bridge appearance appears to be a bit low. Microdroplet Silikon-1000 nasal injections may be considered for permanently raising and straightening a nasal bridge appearance for a more masculine nasal profile appearance, without the inconvenience and expense of revision rhinoplasty surgery. I hope this helps! Sincerely, Dr Joseph

This is not uncommon after scar from a primary rhinoplasty sets in. Again, an in-person exam of the nasal skin would need to be done. But likely what someone could do would be to derotate the nasal tip, use donated rib graft (I use MTF cadaveric frozen rib for revision rhinoplasty patients that I see) to support the tip in its new lowered position, and lengthening the nose with grafts. Starting massage of the nasal skin at least 5 times 5 minutes daily to stretch the skin pocket can help with breaking up the scar and stretching the pocket. Typically revision rhinoplasty rates especially if needing cartilage grafts can range from 25-65K. I see many of this type of patient but I always strongly suggest people to see the original surgeon first as he or she will best know what they have done. However, because many surgeons prefer not to address revision noses I do see many of these from the midwest as well as the coasts. Thanks for your complex but specific question! I hope this helps.