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.

The tip takes the longest time for the swelling to go down and to settle into place. As a specialist in rhinoplasty and revision rhinoplasty surgery, I would advise you to wait the full 12 months to see the final results and to allow all the swelling to go down. Your nasal tip appears to be showing some tip detail and perhaps it just needs more time to heal and for the swelling to resolve. I would advise you to return to your original surgeon to discuss your concerns. The process of helping patients is not just about performing an excellent surgery, but also about the hand-holding that it takes when swelling might be persistent. If after 12 months you are still unhappy and do not wish to return to your original surgeon, you can consider consulting with another board certified plastic surgeon to discuss a revision rhinoplasty.

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.