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

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.