Hi, I had a rhinoplasty a year ago as I had a wide tip.I wanted a more defined bridge and tip,but have ended up with the appearence of a flat bridge from the front and little change to the tip.He also raised the tip which has made my nose appear shorter.I prefered my nose before the surgery. Am I within my rights to go back to my surgeon and voice my concerns?Does he have a duty to fix this?Can anything be done about it,im extremely self consious of it as it is.Any advice greatly appreciated.
Very Self Conscious of Nose Since Rhinoplasty.
Doctor Answers 9
Unhappy with 1 year results
You should certainly voice your concerns to your surgeon and more than likely he/she will agree with you and will want to improve the results
You certainly can and should continue communication with your surgeon. It's very important however to recognize that your surgeon probably tried his or her best to meet your expectations and is just as disappointed as you if you are not happy. If after reviewing the situation and your goals you feel that you still have confidence that he or she can execute what you want then go ahead and make it happen. Unless the new goal is completely different then what the original intent was many surgeons will try to find ways to keep the costs down as much as possible for you. If you don't feel confident with your surgeon then you need to be able to move on without anger and find someone with good experience at revision rhinoplasty and who you are able to connect with. Having been disappointed with the first procedure it can be a hard path psychologically to trust for a second. Be prepared to work these issues out in your own mind as you forge ahead. Avoid looking for a savior or miracle worker, try to find someone who is confident that he or she can accurately diagnose the problems and deliver improvement, not perfection.
Flat bridge and tip
Hey Dels - sorry you are not happy with your nasal surgery - it would seem that the middle part of your nose has either collapsed or has been over resected. The tip is rotating up as a result of the middle nose change - at a year you are probably not going to see much improvement. I would suggest that you find a different surgeon to address your concern - if you feel comfortable returning to your primary then by all means - I would be certain that he is able to see and correct your concern - I am sure that he wants you to be happy but you need to be certain that you can trust that he can fix the problem prior to proceeding again with the same doctor. Good luck!
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Revision Rhinoplasty with previous Rhinoplasty surgeon or not
I have performed Rhinoplasty and Revision Rhinoplasty for over 20 years and I understand your dilemma. There are things that could be done to your nose at this point to make it more attractive, should you decide to do so. Narrow the nasal tip, narrow the bridge and reduce the rotation of the nasal tip. The real question is who would you want to perform that Revision Rhinoplasty surgery?
It's always, well IMHO almost always financially in the patients best interest to try and work out these issues with their previous plastic and cosmetic surgeon as he/she has already done the previous surgery...knows what was done..and has been compensated for that previous work. Going to a new surgeon with a more difficult, Revision Rhinoplasty case, which will surely be more expensive as this new surgeon was not compensated for the previous work, should only be considered if you believe that the previous surgeon is unwilling or unable to aesthetically provide you with what you want done to your nose at this particular time.
I have been in this buisness for a long time and have always believed that every surgeon tries his very best on every case, however there are real differences in the aesthetic judgement as well as training and experience levels...all of which can and do contribute to the final surgical result.
You should definitely return to your rhinoplasty surgeon and express your concern. The middle third deformity may be corrected with a cartilage graft and possibly further tip work.
You can be helped but get good advice
Your changes are the result of skeletal reductions. I can tell that your bridge and tip were reduced, and your tip cartilages, which were rotated up before surgery and loss of structural support (a normal anatomical variant, like blue eyes) have made the tip rounder. You may easily have a new airway obstruction--your airway is almost certainly not optimal, based on what I see. These problems are extremely common and all fixable.
You have the right to tell your surgeon, but that will probably just make both of you feel bad. Your surgeon was doing what he thought would help you, and we have to assume that he did his best. These problems require methodical diagnosis and careful technique by an experienced surgeon with a secondary rhinoplasty specialty. It is important that the next surgeon achieve your goals. Find someone who can demonstrate correction of similar problems in other patients, and someone whom you like and trust.
Very Self Conscious of Nose Since Rhinoplasty
Now that we have a profile view it is obvious that you have an over resected dorsum and lower lateral cartilages have elevated by scar tissues leading to alar retraction and subsequent columella show. As a consequence, the tip has an elevated position and round. There is some supratip fullness. The nose then appears short and angle between your nose and upper lip rather large. The revision rhinoplasty should correct all these problems which must be addressed specifically and sometimes with multiple soultions. See before and after pictures of revision rhinoplasty patients as these are very common findings.
Unexpected result after rhinoplasty
I too like your nose better in the before picture. Of course you should let your surgeon know of your disappointment, 'duty' is legal term and I am not much of a lawyer. I can say that something can be done about your result with a revision rhinoplasty. We find computer simulation an effective way to plan steps and changes in rhinoplasty, and a way to 'try' changes before. We would suggest the same process the second time around to you and your surgeon have a visual goal clearly in mind.
Best of luck,
Very Self Conscious of Nose Since Rhinoplasty.
From the picture on the right it appears that the mid third of your nose has caved in, this may be caused by collapse of the cartilage in the mid one third of the nose, and it can happen after a hump has been removed, this the flat appearance on your photo.
The tip shows pinching on the sides, this creates the appearance that the tip is more bulbous, when in reality its a lack of support on the side walls.
It would be helpful to see profile pictures. It would be helpful to go back and discuss your concerns, and relate this to what the goals of surgery were.
In terms of fixing it, it will be up to your Dr to decide how to proceed.
Michel SIegel, MD
Thank you for the profile picture. It appears that too much cartilage was taken from the bridge, thus causing the collapse from the front and scooped appearance on the profile. Also, too much was removed from the tip, it appears that the nostrils have also retracted and collapsed and thus make your nostrils appear larger.
I would go back and discuss with your surgeon. Although this can be repaired, and I do it all the time, the Dr. must have experience with revision rhinoplasty to achieve a good result. This is also not a simple quick surgery, you will require cartilage to provide support. Stay away from injectables and quick surgeries as it will only make it worse.
Michel Siegel, MD
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.