What went wrong with my revision rhinoplasty? (photo)

Question

I had my 1st rhinoplasty in 2009, that worsened over the years. My revision was with a different surgeon in 2015. It's a lot bulkier now. There is a bulge on the left side of my bridge (more noticeable when I smile), there are lines alongside the base of my nose that are noticeable. Are these my nasal bones? My natural nose was skinniest at the bridge and now it seems to be the widest part, I hate it. Lastly the tip seems detached from the rest of my nose-what does it look like happened?

Steven M. Denenberg, MD · Answer

Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_Mountainocean.html
I made a couple of computer morphs of your nose, and animations of the morphs, to show the changes that are possible for your nose in truly expert hands.
The "lines" around the tip of your nose are the edges of your two tip cartilages, which are visible through your thin skin. Those tip cartilages make the tip look broad on the base views, and they show a bump on the three-quarter views.
The strength of the tip cartilages also holds the tip of the nose down, making it look a little droopy, and it holds the tip of the nose out away from your face.
The woman in the short video at the bottom of my post had her nose shortened in a revision operation. Her tip cartilages were still strong, though not exactly the way yours are strong, but they were holding the tip of the nose down.
In the morphs, I tried to address all of these areas: narrowing the tip, elevating the tip, bringing the tip back closer to your face, softening the borders of the tip cartilages, and then lowering the bride of the nose to match the new smaller position of the tip.The good news is that these changes: elevating the tip, decreasing the prominence of the tip cartilages, are usually reasonably predictable to accomplish, even in a revision, although the operation would be complex.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon, and how to tell whether your primary surgeon should be performing your revision. You should only have surgery if you are able to make yourself very confident in your surgeon's skills. Read that page very carefully. Most plastic surgeons are quite poor at this operation, and I believe my advice will go a long way toward keeping you safe.
I'd love to hear what you think of the morphs. Did they seem to address your main concerns?
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned, and how they fit together, and who can actually accomplish them in surgery.

Geoffrey W. Tobias, MD, FACS · Answer

You have a number of different deformities that appear to have occurred after having an open rhinoplasty performed. The nose has developed a number of sharp angles and lacks a smooth, soft transition from the bridge into the tip. In addition you have ULTRA THIN skin which can fail to camouflage certain technical changes in the underlying cartilage after surgery. During open rhinoplasty it can be sometimes difficult to predict if the placement of sutures and grafts will ultimately lead to  natural and smooth external nasal contours. A revision closed procedure can improve this type of outcome, depending on what surgery was done originally. If you are considering additional surgery it would be wise to have all preoperative photographs and operative notes available for review and analysis. In addition it is important to know if any cartilage has been removed from your septum and or ears, that could be used to reconstruct your nose. The patient that you see in the video below is a revision rhinoplasty with significant refinement of the tip using closed rhinoplasty techniques. This has resulted in a more natural looking feminine nose

Harry V. Wright, MD · Answer

It appears that your the skin of your nose is very thin, allowing you to see every little nuance of the underlying nasal skeleton. The result is distracting and looks surgical. Were the skin envelope thicker you might actually be pleased with your result. Since your surgery was 2 years ago you're looking at your final outcome. It would likely take another surgery -- a 3rd surgery, with the attendant increase in risk -- to improve your result. If your are considering that route it is imperative that you consult with an experienced revision rhinoplasty specialist. Best wishes!  Harry V. Wright MD, Sarasota, Florida

What went wrong with my revision rhinoplasty? (photo)

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What went wrong with my revision rhinoplasty? (photo)

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Our mission is to create a world where every investment in modern beauty is Worth It.