When do you know a rhinoplasty revision is inevitable? (photo)

Hi,I am very sorry you are not happy with the outcome of your surgery. I can see exactly what you are talking about in the photo. The bump is bone and or cartilage and it is not swelling. If you were originally happy with he outcome and now there looks like more of a hump it is because the tip of the nose has dropped. This is very common after endonasal or "closed" rhinoplasty. Endonasal rhinoplasty focuses primary on removing the dorsal hump and not on supporting the nasal tip frequently leading to this issue. I have found open rhinoplasty with an emphasis on tip support is the best way to get consistent excellent outcomes. I would recommend an open revision rhinoplasty for you to support your nasal tip and provide you with the ideal dorsal profile. I would recommend seeing a board certified Facial Plastic Surgeon with extensive experience in open and revision rhinoplasty for consult.

In your photo, I see a distinct break of the straight line that should be confluent from bridge to tip. Likely you were initially happy with your result because the tip was swollen, and when this swelling decreased, the bump “appeared” as the tip became smaller. It is unlikely that this will improve with the passage of time. I would advise you to speak with your original surgeon – but it’s important to know if he or she is very experienced with revision surgery. Are there before-and-after revision-rhinoplasty photos on his or her website? Does your surgeon have decades of experience with rhinoplasty and revision rhinoplasty surgery? If not, you might want to seek other opinions.

As a rule of thumb, revision rhinoplasty should be considered at least one year after original surgery. This assures that minor residual swelling and healing has commenced . It is difficult to assess your particular situation from a photo and it is best to come in and have your nose examined. Possibilities may include soft tissue scar, under-resected lower bridge of the nose and new cartilage or bone formation.

Hi, thank you for the question. It appears that the nose has high cartilage part on the bridge area. It should be refined although I cant evaluate whole nose. A revision may planned after August 22. Regards. Dr Cem Altindag

What is causing the convex shape of your dorsal profile? The nasal bones constitute the upper 1/3 of the nose. the lower 2/3 of the profile is determined by the Cartlidge of the dorsal septum. The convex shape your nose in this area could be due to a number of factors. One of these is excess Cartlidge which would have to be surgically trimmed. A second possibility is a buildup of scar tissue in this area which some surgeons might inject Cortizone to dissolve. The third fact it might be a loss of projection of the nasal tip . A fourth factor is thick skin of a nose which was formally much larger and convex in shape which still has not yet contracted down. If the convexity is due to a combination of scar tissue buildup and thick skin Cortizone might be effective. If it is due to excess Cartlidge and or a loss of projection of the tip surgical removal of the Cartlidge is really the only option if you want a straight profile. Your surgeon should be able to evaluate this by feeling the tissue in this area and distinguishing between Cartlidge versus thick skin and scar tissue.