What went wrong with my rhinoplasty and what can or should be done to fix this? (photo)

Question

I had rhinoplasty almost a year ago in Oct 2018 in Tampa.

Steven M. Denenberg, MD · Answer

The tip of your nose is still big, as you mentioned, and it sits low. Elevating the tip should help quite a bit.
The woman in the short video that I posted with this answer had the tip of her nose elevated and narrowed in her revision operation.
As is typical, too, the three-quarter and frontal views make the nose look even longer -- needing tip elevation -- than the profile views do.
The bump should come down, and all efforts at increasing symmetry of the nose as well.
If I may say, I don't understand the splint. It doesn't look as though it's designed to hold the nasal bones in a precise position, which is the purpose of a good splint.
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 what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes, and probably give you some optimism. From these photos, it seems that there is enough cartilage remaining in your nose to allow most of the desired changes to be possible. (Side note: in my opinion, morphs should always 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 only the surgeon has that information and judgment.)
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, requiring skill that most plastic surgeons don't possess with expertise. For most noses, 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 for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Scott Trimas, MD · Answer

Your nose can definitely be improved to correct both the size, position and width of your nose as well as the tip region. It is difficult to say what occurred with your first rhinoplasty. That being said there are basically two types of issues that require correction in rhinoplasty patients, errors of omission or errors of commission. Typically, when too much tissue is removed then this can result in saddling or collapse in certain parts of your nose like the lower third region below the bump. Errors of omission can occur when not enough tissue is removed in certain areas like the tip region or in the upper aspect of the nose leaving a more prominent hump. Even the best surgeons can have either of these occurrences as the typical revision rate is about 15%. Your options at this point are to go back to your original surgeon to see if he/she will do some additional work for you at a reduced or compensated charge. The other options is too see a board certified facial plastic surgeon in your area who has expertise in revision rhinoplasty procedures.

Thomas Trevisani, MD · Answer

In person exam is essential, as well as reading op-report. Based on photos- it appears that -in the right hands-improvements can be achieved with Revision Rhinoplasty preferably performed through closed technique. Keep in mind that the first time is the best time. It's very important to select a qualified, experienced and skilled Rhinoplasty Surgeon.

Jon F. Harrell, DO, FACS · Answer

I would say that it is essential that you see several experienced nasal surgeons for in person consultations. I would also recommend obtaining a copy of your operative report to share with them. Although you might ultimately choose to return to your previous surgeon it makes sense to get additional opinions. Most surgeons will re-operate on a nose such as yours at the one year mark or thereafter. Revision rhinoplasty is more demanding than primary rhinoplasty but most likely many of your issues can be improved or completely corrected.  Best of Luck  Dr Harrell

Seckin Ulusoy, MD · Answer

Greetings from Istanbul;
Thanks for the really nice question and photo. As I can see from your photos, undesirable some results have occurred after your rhinoplasty. The continue ridge bump (residual dorsal hump) and the depression underneath it ( saddle nose ) , axle curvature, the longer ( crooked nose ), severe withdrawal of the nasal wings ( ala retraction ), not refine and big  nasal tip  . Your indications for revision surgery are abundant. At this stage, it is important to find an experienced nasal surgeon, especially in revision surgery. It looks like probably be able to solve your problems easily by using rib cartilage and muscle membrane. 
Best wishes

William Portuese, MD · Answer

It is difficult to say based on his photographs, however appears to be a crooked brdge line/ nasal bones, a residual dorsal hump, and a small saddle deformity just below the dorsal hump.  It is important to know how much is cartilage left over on the inside of the nose for potential grafting purposes.  Revision rhinoplasty is  more difficult than a primary rhinoplasty, so it is imperative that  you choose the next surgeon based on extensive experience. and closed rhinoplasty approach can accomplish making the required changes to your nose so that it looks very natural

Tarek V. Copty, MD, FACS · Answer

Hi, 
There are several issues that can be addressed to revise your nasal surgery. 
1. We need to straighten the nose, both the cartilagenous and the bony aspects. This may be due to a deviated septum that was not addressed in the original surgery, or it could be due to an asymmetrical bony fracture. 
2. The dorsum of the nose needs to be smoothened to give an almost straight (slightly curved) dorsum. that can be done either by a little more rasping or by adding a piece of cartilage. that will be assessed and answered during examination. 
3. the tip definition needs refinement and some fine touches. this can also be done either by adding or reshaping cartilage. There seems to be mal-rotation and mal-projection to your tip. which means your tip is too long and not curved up the way it should be for a female with your facial esthetics. 
4. at the end of your revision surgery a decision will be made regarding the nostrils. whether any excess skin needs to be removed to achieve perfect symmetry. 
please make sure you see a plastic surgeon who is an expert at Rhinoplasty surgery. 
Tarek V. Copty, MD FACS

Kailash Narasimhan, MD · Answer

Obviously an in-person exam would be necessary to determine exactly what is needed for a revision. After a year the swelling subsides considerably and any asymmetries in the nose can be visible. If there is any contour deformity in the bridge, it is often because there is a step off between the bone and the cartilaginous portions. This area may need to be filed down again. In the tip and columella or base of the nose, swelling takes the longest to resolve. However if there are nostril abnormalities then this may need to also be revised with cartilage crafting. Revision rhinoplasty is a very complex surgery and should be performed by someone does rhinoplasty on a weekly basis. Good luck,
Kailash Narasimhan, MD
Double Board-certified Plastic Surgeon and ENT
Tampa Bay, Florida 
Rhinoplasty specialist 
Npstampabay.com for more photos and rhinoplasty blog

Michael Elam, MD (retired) · Answer

Dear Bluedevilangel, You have multiple concerns with your current result that can be addressed with revision rhinoplasty surgery. You still have a dorsal hump that is accentuated by the slight saddle deformity below the hump and your tip projection needs addressing as well as the drooping of the tip which is more evident in your front photograph. I would suggest that you request your operative report from your primary procedure and take this with you on secondary opinion consultations and discuss the options of correction that are available to you. Best regards, Michael V. Elam, M.D.

What went wrong with my rhinoplasty and what can or should be done to fix this? (photo)

Answers (9)

More Revision Rhinoplasty Questions

1 Year Post Rhinoplasty. How to communicate my lack of satisfaction with the results to MD using proper terminology?

Can I restore a dorsal hump?

Do cadaver cartilage grafts cost more?

Can you use grafts donated from say, your mother or father if they offered to utilize their ear or rib cartilage?

Polly beak again after second rhinoplasty. Why is the happening? (Photo)

WE SEND PRETTY
EMAILS