Revision Rhinoplasty for Tip Refinement 4 Months After Initial Surgery?

I know it's frustrating 4 months after rhinoplasty to look in the mirror and see a round tip. This is normal healing. It takes at least a year or more for the final swelling to fully go down. It is important to allow all the healing to take place, not only to avoid what may be un-necessary revision surgery but allow all the scar tissue to soften and the cartilages to achieve their final contour.

I have had many patients who thought that they might need revisions to further narrow the tip of their nose at 4, 6, even 10 months to find that they love it a year.

Some of the biggest disasters I have seen in consultation for revision rhinoplasty have come after revision surgery was attempted too soon. So, patience is important.

It is normal to see the swelling of the bridge decrease faster than the swelling of the  tip.  The exact reasons for it are not well understood but it is a pattern that is well recognised. When it comes to deciding about revision of the  tip,  it is important that the swelling settles  for a longer period of time,  ideally 9 to 12 months or  even longer. If your concerns are related to the visibility of the columella,  and earlier intervention can take place but it would not be advisable.  It's still better to understand the final shape of the  tip because you can incorporate all the changes that you seek in one revision procedure,  and if when the swelling decreases the nose looks balanced,  you may not need anything.

Dear CupcakeceriIt sounds like you are going through the expected course of recovery from a rhinoplasty. As the swelling of the upper two thirds is reduced, the lower third will proportionately look larger. That is normal. the lower third swelling will go down in the next few weeks. It takes nearly one year for most noses to settle to final shape after rhinoplasty.

Without seeing the frontal view, in all honesty you got a good Rhinoplasty result. The tip swelling always takes longer to go away than the dorsum, because the tip skin is thicker and usually has more oil glands.  You need to be patient and wait a year. 

A concept I always emphasize to my patients regarding maturation of the results in rhinoplasty is that it is not just the swelling of an inflamed tissue that goes down, but actually a contraction phenomenon related to maturation of the scars which is a slow, continuous and dynamic process extending beyond the commonly cited one year interval. That's why most experts discourage patients regarding any interventions during this time, allowing the final results to reveal itself, which often brings more definition to the tip. It is imperative to discuss your concerns openly with your surgeon, allowing him/her to guide you throughout this phase. This will often be reassuring and comforting, even if a touch up or full blown revision becomes necessary at the end.  

Revision rhinoplasty should be considered after swelling from the initial or primary rhinoplasty has resolved. The amount of time for swelling to resolve after rhinoplasty is different for everyone. In general rhinoplasty swelling decreases about 80% in the first two to three weeks after surgery. After three months approximately 90% of the swelling will be gone and it will take up twelve months for the swelling to completely resolve. Individuals with thick nasal skin take longer than thinner skin. The nasal tip will be one of the last areas for swelling to resolve. Patience is necessary to allow swelling to resolve prior to considering revision rhinoplasty.
Best of luck,
Dr. Kaniff

I can understand why you are concerned about the nose not being in perfect balance, however, 4 months is far too early to consider revision surgery.  The tip generally takes the longest for all of the swelling to subside.  In fact, it often takes 9-12 months.  I know it is very difficult, but I would recommend being patient.  From your photo, I actually think the nose is healing well and seems to be relatively well proportioned.  I agree that tip has a fair amount of swelling, but I have seen worse at this stage.  
As the months progress you can discuss with your surgeon the possibility of steroid injections into the tip, which sometimes can be helpful in decreasing swelling.  I suspect that with time you will end up with a very nice result.
Hope that helps and good luck.

Things are yet to settle down fully at just 4 months. It is not uncommon for the tip to take 12 to 18 months to full settle down, so I'd suggest giving it more time before drawing any final conclusions. Time is your friend!

Your nose will be swollen and will remain so for several
weeks. In fact, it takes at least one year for all swelling to subside.

4 months post-surgery is too soon to consider a revision. Typically, my patients see a remarkable decrease in swelling and changes in the appearance of their nose for a couple of months after surgery. After that, even if it feels like visible changes have plateaued, internal healing takes place thought the first year after the procedure. There are subtle changes that won’t be obvious when you look at yourself in the mirror every day, but you will be able to recognize over the course of the first one or two years. If you are still unhappy with the result of your primary surgery after waiting, then it would be time to consider a revision. I know that it’s difficult to wait when you want to see the result that you were hoping for, but try to stay positive! Just keep in mind that the bridge is usually the first area to settle down, but the bridge width and the tip refinement areas usually take the longest. If you are interested in speaking more about your case, I would be happy to see you for a consultation. Best of luck!

Before considering a revision, you need to go back to your original surgeon and be evaluated. It is possible that your tip is still swollen, but it is hard to say without being seen by your doctor. Swelling often times goes down asymmetrically so it could very well be swelling.