I Had Closed Rhinoplasty 6 Months Ago- Unhappy With Results. What Can I Expect From Final Result? (photo)

I had closed rhinoplasty 6 months ago to remove a dorsal hump (see photo) by rasping top and sides. I'm very unhappy with the results so far as my dorsal hump is still showing. What kind of changes should I still expect? Am I stuck with this hump or will it absorb? Also does the area above the tip still look swollen? I would appreciate any advice, as I'm very depressed about my surgery results. My surgeons knows my concerns but he's just protecting his work. I'd like another opinion please.

Doctor Answers 19

Unsatisfactory results after closed rhinoplasty--what to do.

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At 6 months post-op, most (but not all) of your swelling has resolved, scar tissue softened, and sensation and circulation recovered. Based on your photos, you have:

  1. Inadequately-reduced nasal bones, at least with relation to the slightly-more reduced upper lateral cartilages, causing the visible protrusion at the osseocartilagenous junction, and the lack of a smooth nasal profile. This may require osteotomies if an "open-roof" deformity results from additional dorsal bone reduction
  2. Supratip fullness, possibly secondary to scar tissue (the most common cause), but also possible due to inadequate correction of the alar cartilage configuration. This also contributes to:
  3. Sagging nasal tip (inadequate upward rotation of the alar cartilages) and lack of supratip "break"
  4. (No front view available), but if the tip remains too bulbous: inadequate treatment (resection, scoring, and refinement) of the alar cartilages (part of #2)

This is not a result of closed vs. open rhinoplasty, as experts in each method could have achieved better results. Rather, this simply requires more (better) surgery. The timing of surgery is best delayed until there are no further changes being noted, which takes 6-12 months.

If the relationship with your rhinoplasty surgeon is good (sounds like it may not be if your assessment is that he is "protecting his work"), then by all means discuss your exact concerns and expectations with him, including costs. If you are unsure of this, you may wish to seek second opinion elsewhere from ABPS-certified plastic surgeons experienced in rhinoplasty revision or Board-certified otolaryngologists who specialize in revision rhinoplasty. This deserves to be better. There will be additional costs, though your previous surgeon would likely not charge any additional surgeon's fee.

BTW, although HA fillers can improve the appearance temporarily, it does "muddy the waters" for subsequent assessment or surgery, so do not do this unless there is a long delay prior to repeat surgery. Best wishes!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Unhappy with rhinoplasty result 6 months after surgery

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At 6 months, your results from a closed rhinoplasty are pretty stable.  Based on your photos,  revision certainly seems necessary to improve the result and address your concerns.

In a secondary case I would do it in an open fashion with a general take down of the dorsum, particularly to deal with the step off at the proximal third of the dorsum.  The tip needs to be elevated slightly to improve the angel between your lip and columella and also you need a better transition to the tip to remove the poly-beak appearance. 

This could be done at any time and should result in significant improvement. Good luck and thanks for sharing.

I Had Closed Rhinoplasty 6 Months Ago- Unhappy With Results. What Can I Expect From Final Result?

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 You may be nearing the final results at 6 months post Rhinoplasty but you may want to ask your Rhinoplasty Surgeon these questions.  Since no front view was included, it's difficult to see if residual tip swelling exists or if there is an open roof deformity (dorsal hump rasped down without osteotomies to break the nasal bones inward).  From the photos, there appears to be some residual dorsal bone above and dorsal cartilage below a centrally placed indentation.  The nasal tip also appears to be under-rotated.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

6 Month Result after Closed Rhinoplasty

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You do have significant improvement compared to your pre-op appearance, but I do understand your concerns. Although you will wit another 3-6 months I do feel you will have a slight residual hump and a small polly beak which will necessitate a revision. Minimal refinement will give you an excellent result.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Rhinoplasty revision.

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You should discuss the result with your surgeon since I don't know what was said before surgery. Your result won't change much and I'm guessing you will need a revision. See an experienced revision rhinoplasty surgeon for a second opinion before proceeding.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Unhappy with rhinoplasty results

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I believe that your result may be improved.  I would recommend you wait at least 1 year after the original surgery before doing a revision.  This will allow for the majority of edema to resolve.   Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

I Had Closed Rhinoplasty 6 Months Ago- Unhappy With Results. What Can I Expect From Final Result? (photo)

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Agree you will need a revision and 6 months is the minimum time to wait but I recommend at least 2 to 4 more months. 

Rhinoplasty revision

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When I assess patients for dorsal hump removal before surgery I measure the amount in millimeters to remove and how much of the hump is cartilage vs. bone. Sometimes it's 50:50 other times it more cartilage or bone. The reason is because I need to know how much to remove at surgery and the bone responds better to rasping or filing than the cartilage. I cut the required amount of cartilage off and then extend this upward to get the required amount of bone out. Your before photo shows the hump. The after photos definitely show less of a hump but the contour is not smooth. This could be addressed with some additional rasping and the bottom outer edge of the septal cartilage could be taken down a bit more. I would not consider these major revisions of your surgery. It is also far better to take out insufficient amounts than to take out too much as you can always take out more. If you take out too much though replacing the bone/cartilage can be problematic. As long as you have not lost faith in or communication with your surgeon the best person to do that revision is your current surgeon. You just need to decide on timing and that is best done when the swelling has mostly resolved. 6 to 9 months is usually sufficient especially since the revision is not major.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Rhinoplasty, Nose syrgery

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By this time, 6 months after rhinoplasty, your swelling has subsided and more drastic improvement should not be expected. Even though your dorsal hump is moderately reduced, there is room to have more reduction, and to achieve more balanced profile. This is not a very difficult procedure and more pleasing result could be achieved with relatively short period of recovery time.

Irregular Nasal Dorsum after Closed Rhinoplasty

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Dear Rhinoplasty Patient,

I reviewed your nasal profile pictures and it appears that there is insufficient dorsal reduction. The cartilaginous portion of nasal septum at supratip area is still high and there remains some excess bony nasal bone on top. This has created a dorsal irregularity and dip in the middle of your nose. Your may want to wait another six months and have a revision rhinoplasty. I recommend an open rhinoplasty to correct this problem. Just in case you’re hesitant to have another surgery, a non-surgical rhinoplasty using fillers would be a good option as well. Good luck, Dr. Kevin Sadati

Kevin Sadati, DO
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 224 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.