I have thick skin and my nose was broken, I'm 8 months post op. Is this its final form? Thoughts on its appearance? (Photo)

Hello and thank you for your question. Based on your photographs, you may benefit from a revision rhinoplasty with dorsal hump reduction and nasal tip deprojection to help reduce the elongated appearance of your tip. 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

I agree with you about the nose being too long and too protruding. Not just from the 3/4 view. I think you'd like the profile views much better if the tip were substantially higher, too. And then, of course, after elevating the tip and bringing it back closer to your face, lowering the bridge to match the new position of the tip. I doubt that the red spot would be a problem to take care of.

How *much* to elevate the tip, or deproject the nose, or lower the bridge, 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 revision rhinoplasty even more so, 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.

Why no rasp? It won't elevate your tip at all, it won't de-project your tip at all, it can't make the bridge less prominent, the surgeon will probably want to do it in his office under local anesthesia, which, you should never have anything rhinoplasty-wise done in that setting, and at hyper-best it will only address about 1% of the things that you notice about your nose.

If the red bump on your nose has a round and smooth appearance, it may simply be a capillary hemangioma. We treat these in the office with a drop of local anesthetic and light electrocautery. This typical results in a small scab that falls off, and there should be no downtime. It's possible that your rhinoplasty surgeon may not be comfortable with dermatologic electrocautery techniques, or shave biopsies.

I would sit tight for another six months with your nose before considering any anything surgical, since you look particularly swollen in your last photo that reveals your oblique photo. If you can live with the projection of your nasal tip, depending on your examination, microdroplets Silikon 1000 nasal injections may be considered for camouflaging your small profile bump, and that would also lead to the appearance of slightly less nasal tip projection. Sometimes it's helpful to get a second opinion from another local reputable rhinoplasty specialist. I hope this is helpful, and I wish you well moving forward. Sincerely, Dr. Joseph