Revision tip rhinoplasty (10 years ago) - Would surgery help with slightly swollen / crooked results? (photo)

Based on your singular photo, we can see that you have a wide and asymmetrical nasal tip appearance. If this appearances due to asymmetrical underlying tip cartilages, then revision surgery may be considered. I hope this helps! Sincerely, Dr Joseph

Thanks Fearless574724 for your question! Your problems could potentially be resolved with a revision rhinoplasty, but it's crucial to have a comprehensive assessment by a skilled rhinoplasty surgeon. This is the reason:
-Scar Tissue: Scar tissue production is prevalent following several rhinoplasties and can lead to a bloated look, asymmetry, and crookedness. This scar tissue can be removed or reshaped with the use of revision surgery.
-Cartilage and Bone: Your nose's basic anatomy, particularly its cartilage and bone, may have changed as a result of the prior surgery. A revision operation can straighten the nose, enhance symmetry, and refine the tip.
-Risks and Considerations: Because of the changed anatomy and scar tissue that already exists, revision rhinoplasty is more complicated than original rhinoplasty. To reduce risks and get the best result, it's critical to select a surgeon with a lot of expertise in revision cases.
-Speak with an Expert: Look for a rhinoplasty specialist who is board-certified and has a history of successful revision procedures. Seek out images of comparable situations that show before and after.
-Reasonable Expectations: Talk to the surgeon about your objectives, goals, desires and worries, and make sure you have reasonable expectations for what can be accomplished.
-Comprehensive Assessment: The surgeon will look at your nose, evaluate the underlying structure and scar tissue, and decide whether revision surgery is right for you.
As a triple Board-Certified Plastic Surgeon and experienced rhinoplasty surgeon, I specialize in revision rhinoplasty. This complex procedure requires meticulous attention to detail and a deep understanding of facial and nasal anatomy. I am committed to correcting imperfections and restoring both the form and function of the nose. My philosophy is to listen carefully to the goals and desirers of my patients with a focus on patient satisfaction, I utilize advanced techniques to achieve natural-looking and long-lasting results.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

For example, what does the tip of the nose *feel* like? The more the problem is cartilage, that is, the more the current shape and size of the nose is controlled still by the tip cartilages, the more predictable it would be to narrow it. It is possible to carve out excess scar tissue, but that's harder.
Correcting frontal asymmetries like yours is difficult, too, but my optimism in a case like yours is affected by what *else* we might want to do with the nose. For example, do the other views of the nose make it look longer than your ideal? Or more forward-projecting than your ideal? If changes to the length or the projection are done at the same time, it gives more options for ways to correct the asymmetry, and the asymmetry correction usually turns out better.

Hello and thank you for your question.

First off, it's important to recognize that complications happen to ALL surgeons, and any surgeon that does not have complications or any suboptimal results is either not operating enough or lying.

With that said, although an exam in person is ideal, from your photograph alone, I agree that your tip is crooked and asymmetric, and potentially the top and middle third of your nose is also slightly off center. I would recommend a formal revision rhinoplasty which would involve modification of the soft cartilage in your nasal tip, reinforced with rigid cartilage grafts. The cartilage grafts would serve as scaffolding to preserve the long term result. Remember, cartilage grows (and shifts) for the rest of your life -- rigid cartilage grafting is key to maintain the appearance of your nose, especially the tip that has soft cartilage which can deviate to cause asymmetry. I would also place a mastoid fascia tip graft between the reconstructed tip complex and your skin (like a blanket layer over your cartilage and below your nasal skin) to reduce the risk of cartilage prominence (tenting up of the nasal tip skin by cartilage).

Due to your prior rhinoplasty, the cartilage in your septum was likely harvested and you will likely require MTF (Musculoskeletal Transplant Foundation) aka cadaver cartilage to perform this revision rhinoplasty. Also note that if your septum is deviated and you have breathing difficulty, a revision septoplasty may benefit you as well, which can be covered by health insurance.

The next step for you is to pursue the right aesthetic plastic surgeon for your revision rhinoplasty. In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, IN PERSON, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. I also think a key component of your consultation is to establish a good connection with your plastic surgeon. This is difficulty to do without seeing your surgeon in the office, in person. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

From what I can see a revision is the way to go. Your nose is full, twisted, tilting. We should be able to reduce the asymmetry and improve things.

Hello and thank you for your question. Based on your photograph, you may benefit from a tip refining revision rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. This can also be designed to improve the symmetry 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

A tertiary revision rhinoplasty is going to be one of the more difficult procedures to perform correctly in the entire field of cosmetic surgery. Much more information is needed, such as a full set of facial photographs from all angles, in addition to a copy of the operative reports if there are if those are available. It's also very important to know how much cartilage is left over on the inside of your nose for grafting purposes. In addition, if you have thick skin in the tip of your nose, you're not gonna be a very good candidate for this procedure, because thick skin cannot be changed. You're also going to need a full revision rhinoplasty since the mid third of your nose is also concave on your left and convex on the right which is going to require surgical removal of some of the cartilage on one side and a cartilage graft placed on the opposite side. If your nasal bones are crooked, you also need osteotomies. All of this can be performed with a closed rhinoplasty approach with all of the incisions placed on the inside of the nose.