Seeking Second Opinion – Tip Blanching and Stiffness 14 Months Post-Op. What is the best way to correct this? (Photos)

Thanks Intuitive567960 for your question! It sounds like you're experiencing some frustrating issues after your open rhinoplasty. It's quite reasonable that, despite your general satisfaction with the design, you're looking for solutions to deal with the stiffness, blanching, and asymmetry.
It really takes at least 12 -24 months for healing to complete itself after Revision rhinoplasty.
Your nasal tip's rigidity, lack of mobility, and blanching when you smile could be caused by a few things: It could be that a cartilage graft was inserted in the tip to provide it stability, definition, or structure because you stated that you were unaware that one had been used.
Grafts sometimes can feel hard and less mobile than your natural tissue, even though they are necessary to achieve some functional and aesthetic results. Scar tissue can form excessively both internally and outwardly during the healing process following rhinoplasty. This scar tissue may cause the skin to become rigid and tethered, which would limit mobility. The skin may feel tight as it redrapes over the changed underlying structure, particularly at the tip where the alterations are frequently more noticeable. When you smile, the muscles surrounding your nose and upper lip work together. If a graft or scar tissue has made the tip structure more stiff, the skin stretching over it may blanch because the tension will temporarily block blood supply. Under this stretched skin, the prominence of the underlying cartilage is more apparent.
Steroid Injections: To assist soften the region and lessen scar tissue, a surgeon may think about injecting a tiny quantity of corticosteroids into the tip. This method is frequently used to treat stiffness following rhinoplasty, but it must be done carefully to prevent skin thinning. Small or moderate amounts of 5_FU can also be used with success.
Rhinoplasty Revision: Revision rhinoplasty may be a possibility if the blanching and rigidity are really affecting your pleasure. To increase mobility and lessen skin strain, this would include surgically correcting the underlying graft, scar tissue, or tip structure. Because this is a more complex procedure, it's critical to set realistic expectations and locate a highly skilled revision rhinoplasty surgeon.
At 14 months following your treatment, it's a good idea to see a Board-Certified Plastic Surgeon with expertise in revision rhinoplasty. They will be able to: Conduct a comprehensive examination of your nose and identify the cause of your stiffness, blanching, and asymmetry.
Consider your first surgical plan and the techniques used.Talk over the advantages and disadvantages of each possible corrective option in detail.
Set reasonable goals for what more involvement can accomplish.
Bringing pictures of your nose from before your original surgery and current ones that show the trouble spots is beneficial. For any possible revision, be ready to talk about your medical history and your objectives.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

Response:Thank you for describing your experience so clearly—being aware of subtle changes and asking thoughtful questions is a meaningful part of the healing journey.
Your message reflects three key concerns:
1. Tip stiffness and blanching when smiling,2. A sense of unnatural rigidity possibly related to grafting,3. Noticeable asymmetry between the nasal sides.
Here’s how these points are often approached in clinical practice:
1. Healing Timeline and Sensory AdaptationHealing after open rhinoplasty can continue for 18 months or longer—especially when grafts are involved. Firmness at the tip and altered skin behavior (such as blanching or tension) may still evolve during this time. Patients with thinner skin sometimes describe a “shrink-wrapped” sensation as the skin contracts around the cartilage. Sensory adaptation can also take time, and many patients need months to become fully comfortable with how their nose looks and feels after surgery.
2. Distinguishing Postoperative Change from Structural ImbalanceSome of the sensations you're experiencing may be related to natural postoperative changes—others may reflect how your tissues responded to graft placement. Differentiating between expected healing and something that may warrant revision (such as over-projection, scar tethering, or skin thinning) typically involves a detailed in-person assessment.
3. Available Options—From Least to Most InvasiveWhen persistent symptoms are functionally or aesthetically disruptive, treatment paths are usually considered step by step:
No further treatment: If the issue is stable and not worsening, some patients choose to observe over time without intervention.
Subcision-style needling: Occasionally used in rhinoplasty settings to release tethering; while not a mainstream technique in this context, it has been considered a low-risk option in select cases.
Fat grafting (microfat or nanofat): This may improve tissue padding and soften contours, especially if the skin has been compromised by past isotretinoin use.
Surgical revision with fascia: In cases where the graft’s projection causes persistent tip stiffness or visible framework, fascia grafting may be used to soften contours during a secondary procedure.
Each case is unique, and long-term satisfaction often depends on understanding all available options before making a decision. A detailed evaluation by a board-certified plastic surgeon with revision experience can help clarify which—if any—of these approaches align best with your specific situation.
Wishing you continued healing and confidence as you move forward

Based on your photos, you appear to have very thin nasal tip skin. I believe that you are seeing your operated nasal tip cartilages through your relatively thin nasal skin. In our experience, microdroplet Silikon-1000 nasal injections may be an excellent alternative to revision rhinoplasty surgery for creating a less operated nasal tip appearance. I hope this helps! Sincerely, Dr Joseph

Hello and thank you for your question. Based on your photographs, you may benefit from a revision rhinoplasty. Maneuvers for your surgery would include nasal tip deprojection, placement of a mastoid fascia tip graft, among other maneuvers. 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

You have a tip graft - likely something called a shield graft. It is fairly clearly seen through the tip of your nose and creates an unnatural appearance with the blanching you note. In my opinion, this graft should be promptly removed before it creates a more permanent defect. This is something we do frequently for people.

I think you actually have a nice result. If the cartilage graft bothers you the best thing would be to have it removed. But overall it’s a nice result and I would leave it alone

The cartilage is too prominent. You will need a tip revision rhinoplasty to take down the over-prominently cartilage grafts.

Best Wishes,

Gary Horndeski, M.D.

Okay, I'll give you my opinion about all this. The tip graft is too large. That's why it's pressing outward on your skin and causing the blanching and the sharpness. It's off-center to the right, which is why the right side of the tip looks sharper. This is why I don't like tip grafts, except in the rarest of cases: it's just incredibly difficult to have them look natural.

What to do? When something's too large, you make it smaller. I'd go in and trim down the tip graft. A lot. I'd see what your natural tip cartilages look like behind the graft, and if they look natural, I'd remove the graft entirely, so you don't end up with a lesser version of the same complaints. That would entail decreasing the current projection of your tip enough to make it possibly advisable to lower the bridge a bit more, and maybe elevate the tip a bit more, both of which would be aesthetic changes.

I think the suggested corrections are all wrong. Needling will do nothing to improve what you see. Fat injections will make the tip bigger but the fat will not sit between the sharp graft edges and the skin, so the blanching and sharpness won't go away. I don't consider these low risk procedures. Putting fascia between the graft and the skin might decrease the sharpness, but not with any degree of certainty; it certainly would, however, make your tip look huge. And that operation is a real revision with the risks of any revision rhinoplasty.

The way to treat this is to reduce or eliminate the graft, and to be darn sure the reduction is completely adequate on the first try. You don't want more than one additional operation on your nose.a

Much of you describe is simply the consequence of having rhinoplasty surgery.
Without knowing how large the graft is, it’s difficult to know if the graft needs to be reduced in order to reduce blanching.
I don’t think revision surgery is going to serve you, unless you really don’t like the shape of your nose.
None of the described procedures for treating the blanching makes sense to me.
Either live with it or have some of the cartilage removed.
It would be interesting to know if your surgeon removed subcutaneous fat during the rhinoplasty procedure.
I recommend you rely exclusively on in person second opinions for complex things like rhinoplasty revision surgery.
Best,
Mats Hagstrom MD