Revision Rhinoplasty for Tip Refinement 4 Months After Initial Surgery?

I had a closed Rhinoplasty nearly 4 months ago. I have noticed that the swelling has gone from the bridge, but the tip doesnt seem to have gone down as much. I feel that the tip of my nose from the side now looks too big for the top part which has gone down, making my nose look unbalanced. By four months, I feel most of the swelling should have gone in the bridge and tip. Should i think about a revision?

Doctor Answers 63

Rhinoplasty and Tip Swelling

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You still have significant tip swelling four months after your rhinoplasty. I don't see a hanging columella, but there still is a little too much supra-tip and tip fullness. The "ideal" tip to nostril proportion is 1:2 and right now your nose appears to be closer to 1:1. As your swelling resolves your proportions will get better. After one year, you may need a small amount of the supra-tip dorsum removed if the 1:2 balance is still off.

Newport Beach Plastic Surgeon
4.9 out of 5 stars 51 reviews

If the hanging columella is your concern, time will help but can be corrected

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Hey Cupcakeceri,

It's often hard to sit on your hands and do nothing, but as you can tell from all the advice, most people would recommend being patient and letting things settle down. If we go beyond this early advice and think of what may be bothering you about the tip we notice 2 things.

First let's start by saying that overall your nose looks very good for this early stage. The two things we notice are:

  1. You look like you have a slender face, and the tip at this point still looks a little overprojected- sticks a little too far from face,
  2. Part of the roundness we see on profile is because at this early stage you have a bit of a hanging columella - the middle wall between the nostrils is hanging down a bit.

With time you will likely see improvement in both of these things as the swelling settles and the columella settles back a bit.

If part of the roundness that bothers you is the way the columella is sitting you should see someone who can help resolve the problem with the hanging columella. In general, this is a relatively simple thing that can be done under a little sedation with little down time. If this is the issue, let us know and we can be more specific.

As for the projection, again time will help but if it doesn't balance your overall look, in time this can be corrected and there is no need to jump into this early as this can actually complicate any revision you get done.

All in all, you look great and time will resolve much of your concerns.

Warm Regards.

Peyman Solieman, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Don't Revise Your Rhinoplasty Prematurely

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Premature revision of a rhinoplasty is a bad idea. Even if it is obvious that a revision is necessary, you should wait for the healing to be mature. The surgeon should be looking at a stable nose when they start the operation and that is at least a year out. I have practiced for 10 years and can say I see changes for years after surgery.

I trained with a surgeon who had been in practice for 30 years. He had one year post-op rhinoplasty photos of women in their 20's and then new photos of those same women when they showed up 25 years later for a facelift. The noses were smaller! If the only thing that is wrong with your nose at one year is the tip is a little wider than you wanted, wait another year. Five, Ten, and Twenty years down the road, you will be happy you did.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

You should wait a year before revision rhinoplasty

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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.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

Tip Revision 4 Months after Rhinoplasty

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Final maturation with total resolution of tip swelling usually takes longer than 4 months. Your tip does appear relatively big at this time, but it is best to wait up to one year before revision surgery. Serial photographs and examinations will help in the timing of that operation. A young lady like yourself wants this to be the final and definitive procedure.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

4 months is too early for tip Revision Rhinoplasty

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You should definitely wait longer then 4 months before you consider revision rhinoplasty for the tip of your nose. I usually recommend a wait of at least a year but I have gone in earlier on rare occasions. Your surgeon should guide you appropriately if you are unhappy with your nose.

Jason B. Diamond, MD, FACS
Beverly Hills Facial Plastic Surgeon
3.9 out of 5 stars 13 reviews

Revision Rhinoplasty for Tip Refinement 4 Months After Initial Surgery?

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In short, I believe 4 months after rhinoplasty is far too early to consider a revision.  The swelling in the tip can take many more months before fully resolved.  Be patient.

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Tip issues 4 months after rhinoplasty

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Four months is very early after a rhinoplasty.  The tip is the last area to de-swell, and the supratip area in particular can linger in swelling for 12-18 months after surgery.  The reason it takes so long for swelling to decrease is because the scar maturation phase of healing takes that long.  Steroid shots can be beneficial to reduce your swelling faster.  See your surgeon to express your concerns.  If the issues persist at 12 months, then steps toward a revision can be entertained.  Always select your surgeon based on his/her revision rhinoplasty experience.  Ask to view many before/after photos of people who have your similar features.  Good luck!

Thomas T. Le, MD
Baltimore Facial Plastic Surgeon
4.9 out of 5 stars 62 reviews

Tip swelling after rhinoplasty

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Swelling after rhinoplasty can take several months (often 12+) to resolve, especially in the tip. This is especially true if the skin is thicker. Your tip wll likely continue to change over the next several months and up to 1-2 years.

Sam Most, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 69 reviews

It is best to wait before revision Rhinoplasty

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Tip swelling is often the last area to resolve, especially if you had a wide or bulky tip to begin with. It can take up to 12 months for all residual swelling to go away in the tip. A rough rule of thumb is that if your tip still feels on the firm side, there is still swelling there. If it is still firm, gentle finger massage or the back side of an electric toothbrush can help. Most rhinoplasty surgeons will not consider a revision until 12 months from the original procedure.

Farzad R. Nahai, MD
Atlanta Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.