Closed Rhinoplasty Revision Recommendation, Unhappy With Nose Tip.

(32 Y Female), at 20 had a closed rhino, surgeon shaved down a bump, used left over cartilage to fill out two tiny depressions in the tip; and I hadn't even noticed them before he pointed them out. Now the tip of my nose is hard/unnatural feeling (painful if bumped). It appears more bulbous, and from the side more pointy than before. I would like to have the cartilage removed completely from the tip, as a closed rhino, under local anesthetic. Any suggestions, I'm scared of another mistake!

Doctor Answers 8

Closed revision rhinoplasty

Revision rhinoplasty can certainly be entertained to address previous cartilage grafts and surgical alterations to the tip.  This is done under general anesthesia, as it is not minor surgery.  The tip of the nose needs to be fully explored to find out what is causing the issues, which can be accomplished through closed rhinoplasty techniques.  It is important to obtain previous operative record and bring that to your revision rhinoplasty surgeon at the time of the consultation.  This information allows the surgeon to know exactly what was done in previous surgery.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Closed rhinoplasty and revision under local

Revision rhinoplasty is a demanding procedure.  Most of my rhinoplasties I perform are done with anesthesia and open. Open rhinoplasty in my opinion provides the most accurate visualization of  the key structures to allow for a more precise repair of the irregularities and asymmetries. It will also allow for better visualizations of the cartilage graft on the tip that needs to be removed.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Closed Rhinoplasty Revision Recommendation, Unhappy With Nose Tip.

  I have performed Rhinoplasty and Revision Rhinoplasty, for well over 20 years and from what you describe, the onlay cartilage grafts to the nasal tip may have shifted, curled up or partially dissolved creating the asymmetric tip years after the original Rhinoplasty.  Revision Rhinoplasty or even a Revision Tip Plasty could be performed but not under local anesthesia IMHO.  Bleeding from the incisions could make it uncomfortable for you without airway protection.  

  You should send photos or have in person consultations as you may require conchal cartilage grafts (sewn or glued into place) to shape the nasal tip properly.  It's rarely a simple matter of just removing cartilage grafts alone as the nasal tip cartilages were most likely trimmed and manipulated during the original Rhinoplasty...sometimes to the point that not much is left (hence the narrow, pointed tip).

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Tip Revision Rhinoplasty Using Closed Technique

I strongly advise you to pick an experienced revision rhinoplasty surgeon who has many examples of natural results in patients with problems similar to yours, not the technique. If you want this to be the last rhinoplasty of your life, it is best not to tell your surgeon how to do the operation. Several consultations may help you decide who will do your surgery. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Closed Revisional Rhinoplasty

It is possible to revise the tip using closed rhinoplasy. Virtually all of my primary and revisional rhinoplasties are done with a closed technique. This is typically done under general anesthesia. There is often quite a bit of scar encounted during revisional rhinoplasty, and it is best that the paient is under anesthesia. I advise you find an experienced plastic surgeon who is comfortable with revisional rhinoplasty.

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 30 reviews

Revision Rhinoplasty

I'm sorry to hear about your experience.  Cartilage, scar tissue, or both may be contributing to what you describe. Removing tip cartilage that has now scarred down is not as simple as you may think and usually requires an open approach.  It is hard to say whether or not your situation could be addressed under local anesthesia as a closed rhinoplasty.  Please consult with your surgeon or a board certified revision rhino specialist who can best help you achieve the results you desire.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Closed rhinoplasty revision

I'm sorry you have this problem but would recommend you get a second opinion if you are unsure. Find a surgeon with experience in revision rhinoplasty. Most surgeons will do revision tip surgery under anesthesia and using an open rhinoplasty approach. The cartilage graft may simply be too thick and need carving to create a more natural appearing refined nasal tip. Good luck.

Richard Chaffoo, MD, FACS
San Diego Plastic Surgeon
4.8 out of 5 stars 23 reviews

Nasal tip bulbous and pointy after graft

It is possible that the cartilage graft in the area is causing the concerns you mention. Scar tissue may also be at play. You may want to ask your original surgeon his thoughts about revising the area. It should be possible to remove the graft in the area, but it is hard to say for certain without an examination.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 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.