Cooked Nose Tip After Rhinoplasty. Surgeon Said Second Rhino is Risky. Need a Second Opinion? (photo)

Hello dear doctors! Around 14 yrs ago, I underwent a Rhinoplasty procedure. However, a few years ago (5 or so), I started to notice the tip of my nose crooked to one side. I consulted a surgeon and he said a second Rhinoplasty would be very risky and he would rather recommend someone specialized on these cases. My questions: Generally speaking, how high is the risk for complications under a similar scenario? Is it possible to correct this with fillers or another method? Thank you for your time!

Doctor Answers 10

Revision rhinoplasty

I would not recommend using fillers to help improve the appearance of a crooked nose. I have seen too many complications arise when using fillers for a non-surgical rhinoplasty. These complications may include asymmetry, rejection, and necrosis (the tissue dies). Revision rhinoplasty is a very difficult procedure, and requires a specialist with a great deal of experience to obtain an optimal result. And correcting a crooked nose is generally very difficult as well. It is possible to make a great improvement, but hard to get the nose 100% straight.  I would recommend a consultation with a board certified revision rhinoplasty specialist, as he/she will be able to provide you with the best advice and recommend treatment options. Thank you, and best of luck to you.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 47 reviews

Revision rhino after 14 years to address crooked tip

revision rhinoplasty is a complex endevour and there is the potential for dissapointment.  with that said, your surgeon is very wise to recommend that you see someone with experience.  often revision rhinoplasty requires re-working/ re-shaping the existing cartilage and borrowing cartilage from the ears or ribs.  as you visit with surgeons if they do not mention this, I would suggest at least brining up the possibility of grafts.  if this idea is forign to them than revision rhinoplasty is too.  looking at your photos, improvement of the tip shape and symmetry is a reasonable expectation.  i would add to that the gal of decreasing nostril show on frontal view.  fillers are an option for minor changes in the nose BUT there is a much greater risk of tissue necrosis as you do this closer to the tip so use someone experienced

Adam Bryce Weinfeld, MD
Austin Plastic Surgeon
4.9 out of 5 stars 58 reviews

Risk of Revision Rhinoplasty

As you know there is some risk in every operation. Putting this in perspective, the surgeon that wanted you to see a revision rhinoplasty specialist was correct because revisions are a specialized area of rhinoplasty surgery.Your asymmetrical, deviated tip with nostril rim retraction is best treated with a revision. I may sound biased because over half of my rhinoplasty practice is revision surgery, but I feel there is more risk of complications with fillers in the tip.

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

Revision Rhinoplasty

It would be only risky if you had the revision surgery with an inexperienced rhinoplasty surgeon. Maybe that's why your surgeon told you it would be too risky. It looks like you may have an inverted V deformity and some tip asymetry. This can all be remedied with a revision rhinoplasty. I don't think injectable fillers will give you any long term results.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 274 reviews

Revision not risky

Your revision, if performed by an experienced surgeon in revision rhinoplasty should have minimal risk.  It is possible that your surgeon does not want to or is not able to perform the revision that you need, but based on your photo the risk does not appear to be a problem

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Revision Rhinoplasty should be done by those who specialize in this area

The risk of complications for your problem would seem to be pretty low hands experienced in rhinoplasty. I would guess that the greatest risk to you would be that you don't like what your nose looks like after surgery. Fillers can be used to camouflage certain area, but can't fix areas that are crooked. Fillers are usually reserved for areas that need more volume but it can't move the nose. Only surgery can do that.

Listen to your surgeon and seek out a specialist. Rhinoplasty is one, if not the most, difficult operation in all of plastic surgery due to the nose's complex 3D anatomy and it's dual roles in both form and function. Revision rhinoplasty is even more difficult due to scarring and the disturbance of once "virgin" surgical planes.

Therefore, you really need to see a specialist that performs a high volume of rhinoplasty. If it's listed at the bottom half of the list of procedures that they perform, then I suggest looking elsewhere. For best results, you don't want someone who "dabbles" in nasal surgery. Ask for pictures of previous patients and meet with more than one surgeon so that you feel comfortable with your surgeon's philosophy and level of experience in this area. The cost of multiple consultations is small change compared to cost of a bad result.

Michael M. Kim, MD

Michael M. Kim, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Are secondary Rhinoplasty surgeries risky?

The risk is primarily in not correcting the issue you are concerned about. The first step is determining if your concerns are significant enough to be noticed by the surgeon and if so, what is causing the problem - in other words- making an accurate diagnosis. Most experienced Rhinoplasty surgeons will be able to determine if your concerns are reasonable and how likely they would be to correct the deformity you are noticing. Best of Luck  Dr Harrell

Jon F. Harrell, DO, FACS
Miami Plastic Surgeon
4.9 out of 5 stars 49 reviews

Revision rhinoplasty

Revision rhinoplasty even for the most minor problem should be done by one specializing in this field. It is not totally risk free in this case but the risk is minimal

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

Revision rhinoplasty

Without an exam, it is hard to say what could be done for you or not.  It is difficult to say from the photos you posted.

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

You would need to post better photos for advice on Revision Rhinoplasty or Non-Surgical Rhinoplasty.

I read your concerns and reviewed your photos:

You appear to have thin skin, excessive nostril-show, and your "crooked" appearance may be from a deviation of the bottom of your septum.

In my practice, I like to reserve revision rhinoplasty as a last resort, and many people with rhinoplasty-related irregularities benefit from non-surgical rhinoplasty procedures. My expertise is with Silikon-1000, an off-label filler for permanent results.

Feel free to re-ask your query with better photos that demonstrate your concerns and please describe what you would like to achieve.

Hope this is helpful.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 421 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.