Post rhino: pointed, overprojected tip, nostril retraction, low columella etc. Unhappy with outcome. Any suggestions? (photos)

Question

I had open rhinoplasty with LLC grafts 2 months ago. I don't understand why my results look nothing like my goal. The nose appears longer than pre-op and is unflatteringly pointed and bottom heavy with too much nostril show. I feel it is aesthetically less than ideal. Clearly there is much swelling, but will time really make a significant difference/round the tip or will I eventually need a 2nd surgery to achieve the original goal? Please share your candid observations. Thank you in advance.

Frank P. Fechner, MD · Answer

Although early in your healing, I don't think that you concerns will disappear. If anything, your tip will become more pointed and the retraction of the alae will worsen. I would consider revision rhinoplasty with your surgeon not earlier than 1 year after the original surgery.

Stephen Weber MD, FACS · Answer

You are absolutely correct that you're early in the healing process. However, after looking at your photos and reading your concerns it sounds likely that a revision will be needed to achieve your goal. I agree that your tip is pointed and your nose still long and over projected. Rhinoplasty can be very, very challenging and every surgeon ends up revising some (hopefully a small number) of even their own results. I would give yourself more time to heal. If you continue to trust your surgeon and think that they can refine your nose in the future, this is ideal. If you have concerns based on the first procedure, it never hurts to seek a second opinion. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Thomas Funcik, MD · Answer

Elizabethian-Your assessment of your situation is accurate, you may indeed be headed towards a revision.  I am going to try to give you some helpful information, but it will only be worth what you paid me for it!  Seriously, by that I mean to say the only way to properly assess your situation and make recommendations is to perform a proper exam in person, wait for the nose to heal and swelling subside, review the prior operative report, etc.Do not feel to bad, it is not a horrible outcome from what I can see.  Unfortunately, even the most skilled surgeon has to revise some of his/her own rhinoplasties.  One initial observation is that an under correction is almost always easier than an over correction.  There is usually more cartilage to work with.  One of the first things I would assess is how much septal cartilage is left behind to be used in the revision.  The more the better. If you can still work with your original surgeon and he is capable of improving the outcome, that is always better (reduced fees, he knows exactly what is done, etc.).  But unfortunately, revision work is more challenging than primary due to scar tissue, etc.I wish I understood what exactly is meant by LLC grafts.  Grafts are not used as commonly in primary cases as secondary cases. Occasionally, a tip graft can shift or "tombstone" and the borders can show through thin skin such as yours.  If that is the case, sometimes the "fix" is easy and it is simply a matter of shaving down the graft, re-positioning it, or camouflaging it with some soft tissue.

Sean Maguire, MD · Answer

Based on your photos and what you describe as your operation. it is possible that your lower lateral cartilage strut grafts may be a bit too large and a bit too long, causing overprojection of the nasal tip. having said that, it is still fairly early in the post-operative course to make a decision about this. As I'm sure your surgeon explained, it really is a year or so before swelling completely resolves and the final result is seen. I would recommend that you discuss your concerns with your surgeon.

Post rhino: pointed, overprojected tip, nostril retraction, low columella etc. Unhappy with outcome. Any suggestions? (photos)

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