Uneven columella / tip after two surgeries - can this be improved? (Photos)

Question

I am 30 years old, I had my first rhinoplasty in 2017. I got the surgery because I was very insecure as I had a "beak" nose and always hated it. After my first surgery (with a surgeon in NJ), I was very pleased with the bridge and shape of the nose but as time went on, the right side of my nose began to droop and twist. In 2021, I decided to get a revision with a surgeon in Chicago, again, initially was very pleased with the results but then the right side began to droop and twist. I had a revision with that same doctor in 2023, and the exact same thing happened. At this point I have no idea why this keeps happening, I'm afraid to keep going under the knife as my tip seems to be getting smaller and more pointy. Why would this be happening? What should I do / not do?

Steven M. Denenberg, MD · Answer

Even after three attempts, your nose, at least from these photos, is still very strong in its forward projection away from your face. That, and the fact that the bridge seems prominent on the 3/4 view where you're not smiling, make the nose look long as well, with the tip sitting lower than it has to. I don't know why the other operations failed -- I usually think of decreasing the projection and elevating the tip as two of the more predictable changes to make in a rhinoplasty, even a revision.

It would be nice to see a full set of photos, posed like you did for this question post, but starting from one profile and going around a little at a time to the other profile. Morphs could be made from the photos to give you an idea of what's possible: you'd understand better what might be the main target of another rhinoplasty if you decided to have it.

In general, the more we want to change a nose -- changes measured in millimeters -- the more likely it is to succeed. Tiny tweaks are difficult to make with any predictability. If morphs of your nose that you like show a significant change, that would be optimistic for another try.

All due respect, I would not use the surgeon who did your second and third operations. There is some evidence there that he might lack whatever expertise or assessments or judgements that are required for your nose.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Uneven columella / tip after two surgeries - can this be improved? (Photos)

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Everything you need to know about Revision Rhinoplasty

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Uneven columella / tip after two surgeries - can this be improved? (Photos)

Answers (2)

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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.