2 years post revision rhinoplasty, considering another procedure - Are there other options that can target my concerns? (photo)

Question

I'm two years post revision rhinoplasty. He said he would do a revision but that there's a 30 or so percent chance that it's going to create additional problems, specifically with potential scar tissue and unevenness and healing. The concerns I have are the tip points are palpable to the touch and one is slightly visible at times. In addition, the graft and the bridge of my nose has a little puffiness over it and can be seen a bit. Are there safer, more predictable options?

Nima Shemirani, MD · Answer

Hi @newnose2018! Thank you for sending your photos. I recommend seeing a revision rhinoplasty specialist for in person examination. There are several options for you that can be determined after examination. A rhinoplasty in my opinion is one of the most difficult procedures to perform. In my practice, I utilize piezosurgery. Piezosurgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezosurgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures. Best of Luck, Dr. Nima!

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have a nice result! That said, if you are seeing edges of nasal tip cartilage, that's because you have this skin, and they may be referred to as "bossae". We have had excellent success camouflaging nasal tip cartilages with microdroplet Silikon-1000, a permanent filler. Depending on your exam, Silikon may be considered for smoothing the top of your bridge graft. Hope this helps! Dr Joseph

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Thanks for the questions. I agree that revision procedures can lead to untoward outcomes like scarring and new deformities. That being said, there are other options. I would try steroid injections - even two years out - to see if the swelling improves. Taping and tip compressions can help as well. As for the prominence of the tip cartilages, that may require trimming via a revision procedure. To soften the tip, temporalis fascia can be placed which helps with camouflage. It's never a bad idea to get multiple opinions on what may be best for you. Seek consultation with a facial plastic surgeon who performs rhinoplasty often. Best of luck!

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