Considering a Second Revision for Ongoing Tip and Alignment Problems - what further options are available? (Photos)

Question

I had a septorhinoplasty in Feb 2021 for breathing issues from a deviated septum and to address a dorsal hump and drooping tip. The hump was reduced, but breathing problems persisted and the nose remained bent with an asymmetric droopy tip. A new consultant also noted significant columellar scarring. I underwent a revision septorhinoplasty in July 2024 to improve breathing and symmetry. This involved an open approach, reconstruction of the anterior septum using frozen rib cartilage, and tip symmetrisation with a full release technique and lateral crural strut grafts. By three months post-op, a persistent bend in the lower third of the nose to the right was evident. At one year, the left side remained more swollen. On the consultant’s advice, I had three rounds of low-dose steroid injections to the left supratip, which reduced the asymmetry in fullness. A few issues remain: the tip appears overprojected, the lower nose curves noticeably to the right, and the columella hangs low and looks asymmetric due to the overall curvature. My consultant believes these stem from underlying facial asymmetry—such as differing alar base positions and discrepancies between facial and jaw alignment—and may not be correctable. I recognise the improvement since the revision but want to know whether any further options exist to address the remaining tip concerns.

Eyup Bozkurt, MD · Answer

From your photos, it’s clear that there is a significant structural asymmetry in the nose. While facial asymmetry exists in everyone, the degree and pattern of asymmetry in your nose cannot be explained solely by facial imbalance. The cartilage placed in the columellar area does not appear to be sitting on the midline, and it is also noticeably descending downward.In a revision rhinoplasty, the first step would be to reconstruct the L-strut properly and to reshape and reposition the columellar–tip graft so that it sits straight and provides stable central support. You also have alar collapse on the right side, which would need to be addressed as part of the correction.One important point: even with a well-planned revision surgery, about 80–85% of the deviation and asymmetry can be corrected, but 10–15% of residual asymmetry typically remains. In other words, the nose can look much straighter and more balanced than now, but a perfectly symmetrical result is not realistic.I would strongly recommend having a professional consultation to evaluate the grafts, cartilage support, and soft-tissue behaviour in detail before making any decisions.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. This can be designed to straighten your tip. 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.
Harvard-trained plastic surgeon

Best wishes and good luck.

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

Considering a Second Revision for Ongoing Tip and Alignment Problems - what further options are available? (Photos)

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