Revision rhinoplasty - is there any hope to make my nose less bulbous? (Photo)

Question

Hello. I have had three rhinoplasties done and I am extremely disappointed in how the third one turned out. My nose is more bulbous than before. The surgeon said it would go down and it did some after the procedure but it is very bulbous and wide. I had this done last in 2017 and I have been searching for a surgeon skilled in revisions. My nose is also projected more than before. I am so depressed. Is there any hope?

Thomas A. Mustoe, MD, FACS · Answer

I have had success in improving tio definition and bulbous appearance by meticulously dissecting out and removing scar tissue: combined with taping and regular injections monthly.  You do have thick skin and that does limit what is achievable but based on your pictures I am optimistic.

John L. Burns Jr., MD · Answer

Revision rhinoplasty is very difficult and becomes more so with each subsequent procedure.  Whatever you decide I'd seek out the most experienced surgeon available and be very clear with your goals and expectations.

Steven M. Denenberg, MD · Answer

I'll try to tell you everything I can, based on your history and these two photos.

The thick skin on your cheeks suggests thicker-than-average skin on the nose, which gets in the way of a good result, but the frontal photo tends to show the width of *cartilages*, not so much of skin, and the bridge just above the tip seems wide, too. If those areas are indeed wide because of cartilage, that bodes well for more improvement. If it's all soft, thick skin and scar, that's less optimistic.

The profile view, to my eye, doesn't show a prominent over-projection as much as it shows a low tip that could be elevated. In a situation where we're trying to keep things as narrow as possible, then keeping some projection is good, and when the tip of a nose is *elevated*, making the nose shorter, the tip doesn't *appear* as projecting as it did when the tip was lower. I hope this is making some sense.

So from my standpoint, if I were to *feel* the nose, if the width of the tip and lower bridge *feel* like cartilage, and an inspection inside the nose indicates lots of cartilage still remaining in the tip, then that would move me toward offering another operation. And if everything just felt, as I said, like scar and super-thick skin, then maybe not so much. Photos do a good job of telling us what a nose *looks* like, but we don't have a way to post something that tells what it *feels* like, and that can be very important.

How *much* to elevate the tip, or consider deprojection, or make other changes? 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 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.

Revision rhinoplasty - is there any hope to make my nose less bulbous? (Photo)

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Everything you need to know about Revision Rhinoplasty

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Revision rhinoplasty - is there any hope to make my nose less bulbous? (Photo)

Answers (3)

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.