8 years post-op rhinoplasty for dorsal hump - is shrinking bulbous tip possible? (Photos)

You have a persistent hump, supratip saddle deformity, and drooping tip on animation after a prior rhinoplasty. It is not unreasonable to desire a revision, and a revision could certainly improve on your concerns and more closely approximate your goal photographs.

It is difficult to make recommendations based on a pair of lateral profile views alone. I would recommend seeing a board-certified plastic surgeon (with a 6 year integrated plastic surgery residency and The Aesthetic Society accredited aesthetic fellowship) for a consultation. I would recommend a physical exam in person to further evaluate what is going on with the nose.

Based on your photos, you are a great candidate for revision rhinoplasty. You bridge is somewhat over resected, causing loss of support of your tip. Ideally, you would need a combination of building up the bridge a bit and deprojecting and supporting the tip so it's smaller and doesn't droop. Be sure to see a rhinoplasty specialist who can also do computer imaging at the consultation.

That said, the feasibility of undergoing rhinoplasty surgery again would require an examination. And our experience, you would need to have cartilage grafting to support the position of a deep projected and rotated nasal tip appearance. The best place to harvest cartilage is from your nasal septum. If you had previous septal surgery performed, cartilage grafting utilizing rib cartilage might need to be considered. Hope this is helpful and I wish you well moving forward. Sincerely, Dr Joseph

Currently, besides the residual bump high on the bridge, the tip of the nose sits too low (needs to be elevated), and it's too projecting, which means it comes out forward strongly away from your face. On the morph, I would do more of a job bringing the tip back closer to the face, and elevate the tip more (but of course, to keep it looking attractive, not artificial). When that's done, the dent just above the tip would almost all be gone, or mostly, and we wouldn't have to consider putting material in there, something that begs for another complication or irregularity.

Also, lowering the bump higher on the bridge would make the "dent" just above the tip look even less like a dent. I don't think it's a dent.

You might have a "bulbous" tip, but what I think about when I think "bulbous" is a *wide* tip, when seen from the frontal or 3/4 views, like the patient whose before and after I posted with this answer. From the direct profile view, it's hard to tell how *wide* the tip is. What we can see here is that the tip is prominent.

How *much* to elevate the tip, or deproject the tip, or lower the bump up higher, or make other changes? And how to tell if I'm right and the dent isn't really a dent? 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. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. 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 seriously 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.

So, you have what we call a "saddle nose". This is, in your case, likely from removing too much cartilage on the top of the nose at the time of your prior surgery. Achieving the result you are looking for is possibly by restoring that cartilage. This is a long winded way of saying, yes, it can be done! Should take about 90 minutes and one week with a taped nose. Watch our videos to learn more.

After large hump resection, your nose seems to have a middle vault saddle nose deformity and it makes your tip more bulbous. The photoshopped image shows that you want to fix the saddle and make the tip look less bulbous and less droopy when you smile. I personally think your wish is reasonable and it can be achieved with revision rhinoplasty. Do find another doctor nearby who has enough experience in revision rhinoplasty and ask for help. Thank you.

A full set of facial photographs from all angles and a copy of your operative report would be helpful to understand what was accomplished in the first procedure. The digital images that you presented are possible with a revision rhinoplasty procedure. You're going to require cartilage grafting techniques to build up the area area on the bridge above the tip, that is slightly depressed. To prevent the tip of your nose from drooping down dynamically when your smile requires releasing of the depressor septi ligament. It's important to know how much cartilage is left over on the inside of your nose for grafting purposes. Revision rhinoplasty is very difficult, so choose your surgeon wisely based on extensive experience.

To make an accurate assessment and have a better understanding on the outcome of your procedure we generally need to see a complete set of proper before and after pictures of your previous operation.
If you don’t have access to before and after pictures, then try to contact that provider and ask him or her to forward the pictures they took.
Without knowing what you look like before the operation or what was done it’s hard to give you a good assessment, and therefore difficult to give you a good recommendation.
Rhinoplasty surgery is considered fairly complex and providers should look for highly experienced providers who have a strong background in this procedure before scheduling surgery.
Considering that revision work is many times more difficult than primary rhinoplasty. The importance of provider selection becomes even greater.
It may be possible to get results consistent with the pictures on the right, but finding a provider who can may not be easy or straightforward. A lot depends on what was done during the first procedure.
Best,
Matt Hagstrom, MD