Potential third rhinoplasty. I don’t like my bridge and the tip. What questions should I ask a revision surgeon? (Photos)

Question

I have seen a couple of surgeons. I don’t like that the tip of my nose deviates. The tip is over-projected after my second rhinoplasty. I alos need a rib graft. Am I overdoing it or it achievable to fix these issues? One surgeon said he can raise the tip a bit and bring the bridge back up but said he would widen the bridge but not sure he could fix the fact that the tip deviates. He said it was a 9/10 complexity but i feel like my nose isn’t horrible. I just would love to finesse it especailly now that cadaver rib is more readily available. 1st surgery was 13 years ago and second was three years ago. PS it’s so hard to choose a surgeon because it’s revision and even the good ones have some bad reviews. I even saw someone in beverly hills but he pricing was double what id pay here in san diego. Wouod love input - am i being realsitic? Leave the nose alone? Can it be improved and what are chance of still not being happy with it? Weighing the pros and cons is way harder for a third surgery.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. 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. FACS
Harvard-trained board certified plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D. FACS
Harvard-trained board certified plastic surgeon

Steven M. Denenberg, MD · Answer

Oh, boy, I think a rib graft for your nose would be awful. I'll tell you what I see. Your nose is very long, with "long" measured from where it begins between your eyes down along the bridge to the tip. It's long because the tip is lower than we would like it, droopy, but also because your midface -- the distance from your eyes down to where your lips meet -- is tall compared to the height of the rest of your face, and a nose occupies most of the midface. So we want to see that nose shorter. That's done by raising the tip (raising it a lot, no offense), and also by *lowering* the bridge at the very top, just under your eyebrows. Not elevating it with a rib graft.

From the front your nose looks quite wide. Those bumps are probably pieces of cartilage that need to be trimmed or have their positions adjusted.

Your tip is also strong in its forward projection away from your face. I think the tip should be brought back closer to your face. That's called "deprojecting" the tip.

I personally think your nose looks too big for your face, in a few different ways. If someone were to put a rib graft along the bridge to build it up, it would make your nose look substantially bigger than it looks now, and I just don't think that's the direction you want to go. You may often hear that making something bigger can make the overall thing *look* smaller. That's the rationale behind non-surgical rhinoplasties with filler. But I'm a simpleton from Omaha. I think, if you make something bigger, it will look bigger.

Your nose has the appearance of a nose that started out long, with a bump on the bridge, and the surgeon(s) removed the bump, but didn't shorten the nose. And removing a bump tends to make a nose *look* longer yet. Then, when you remove a bump, it makes the nose look wider, but the surgeons didn't narrow the nose. This is a common set of problems to have, because it turns out that elevating the tip of a nose and bringing the tip back closer to the face is not a trivial problem, and most rhinoplasty surgeons cannot accomplish it.

The deviation of the tip is a non-issue. If your nose were changed in the way I picture, the tip would move up and back, and that would give opportunities to set the tip in the midline, or close to the midline. Also, when a nose gets shorter and smaller, any remaining asymmetries are part of a smaller nose, so they look smaller, too. And your asymmetries (including the bumps you circled) are not the biggest part of the project.

Your nose is an excellent example of why having computer morphs made by the surgeon are 100% mandatory. You need to know what the surgeon is picturing for your nose, so you can love it or reject it or fine tune it. I think if you see a morph with the bridge built up with a rib graft, you'd be horrified.

I was going to say that's my two cents, but it looks more like three or four.

Julian De Silva, MD · Answer

Hi Warmhearted250824, thank you, this is exactly the right question to ask before committing. You are not overdoing it by wanting clarity, but a third operation is where honesty and planning matter most, because scar tissue and depleted cartilage change everything. Questions I would ask any revision surgeon: How many revision rhinoplasties do you perform each year, and how many were third or later operations? What exactly is causing my tip deviation, and can you show me on my photographs? What graft material do you plan and why that choice for me, whether your own rib, cadaver rib or ear cartilage, and what are the trade-offs of each? What can this operation realistically not fix? What is the plan if the tip cannot be fully straightened? How would you manage a complication or a result we are both unhappy with? A surgeon who rates a case 9 out of 10 for complexity and tells you so is being honest, and honesty is worth a great deal in revision work. Choose the surgeon whose explanation of your anatomy makes the most sense after an in-person examination. Results vary between individuals and no outcome can ever be guaranteed.

Ekrem Korucuk, MD · Answer

For a third rhinoplasty, choosing a surgeon with significant experience in revision rhinoplasty is especially important. I would recommend asking how often they perform revision cases, what they believe is causing the problems you see in the bridge and tip, and what can realistically be improved.You should also ask whether additional cartilage may be needed and, if so, where it would come from, such as the ear or rib. It is equally important to discuss nasal breathing and structural support, not only appearance.During the consultation, your surgeon should carefully examine your skin, existing scar tissue, nasal support, and previous surgical changes before proposing a plan. In a third rhinoplasty, the goal should not necessarily be a “perfect” nose, but a safe, natural-looking and realistic improvement.Ekrem Korucuk, MDENT & Facial Plastic Surgery

Potential third rhinoplasty. I don’t like my bridge and the tip. What questions should I ask a revision surgeon? (Photos)

Answers (4)

More Revision Rhinoplasty Questions

Can an upturned nose tip be made droopy again?

Large hump after rhinoplasty (9 years post op) - will this require a full revision? (Photo)

Is it safe to pierce near a dent left after rhinoplasty revision?

9 years post primary - should I go back to original surgeon if I did not love my results? (Photos)

Revision rhinoplasty - Can a square, boxy tip be restored? (Photo)

40 years post rhinoplasty - Can nostril symmetry be improved? (Photos)

WE SEND PRETTY
EMAILS