Interested in 3rd rhinoplasty revision. Tip hangs low when smiling. (photos)

Other stuff I can live with ...

Doctor Answers 7

Revision rhinoplasty needs to be a complete operation...

while I get that you might want to fix only those issues that are most compelling to you, nothing in rhinoplasty occurs in a vacuum...cautious attempts to provide small fixes are never satisfactory and only make the ultimate fix more difficult

you have many issues which all stem from the over-resecting and destructive methods of the past...the decision to undergo a revision rhinoplasty needs to be considered carefully ..Unfortunately, unsatisfactory results and secondary deformities from primary rhinoplasty are common.... like many other advances in science and technology, the techniques and approaches to rhinoplasty have become significantly refined over the last 20 years..... much of what is done now by qualified rhinoplasty specialists is much more 'constructive' than the 'destructive' methods of the past....You need a thorough evaluation and a well thought out will need to gain the confidence that your surgeon has the skills and aesthetic judgment to fix your will need to see several doctors to become convinced of what an actual expert is...find out who OR nurses and doctors go to and where they send their family/friends .... do your homework and be sure that your revision rhinoplasty surgeon has: 

1. many years of rhinoplasty practice experience

2. judgment and techniques that have evolved over time 

3. a practice focused on rhinoplasty  

4. a willingness to do difficult, secondary and reconstructive cases 

5. an interest in teaching others how to evaluate and do rhinoplasty properly

6. a willingness to share rhinoplasty resume, photos and patient experiences with prospective patients 

Hackensack Plastic Surgeon
5.0 out of 5 stars 9 reviews

Revision Rhinoplasty

I think despite best intentions your surgeon failed to recognize a not rare variant in noses, cephalically or malpositioned lower lateral cartledges. The surgeons reading this will certainly understand. You can't do what works well for most other reduction rhinoplasties. You will need extensive cartledge grafting and repositioning of the tip cartledge that would rotate the tip upwards. This is not one for beginners, final a very experienced rhinoplasty surgeon.

J. Smythe Rich, MD
Columbia Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews


 A revision to reduce your infratip lobule would be indicated.  You also appear to have a deviated caudal septum and a polybeak deformity.  This can be addressed in a revision as well.  

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 52 reviews

Revision rhinoplasty?

You have several issues which can be corrected but you will need ear cartilage grafting probably done by a very experienced revision rhinoplasty surgeon. Look at before after photos of the surgeons work..

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

3rd rhinoplasty

Do not take this lightly. From your limited photos you appear to have deviated septum and columella, alar retraction, possible poly beak vs over resected dorsum. Correcting all these issues my require extensive structural grafting and if you have already had two surgeries then you probably don't have much nasal cartilage left. This may require rib or ear grafting. Be sure to get a thorough opinion from someone who regularly does these kind of procedures.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Interested in third rhinoplasty revision

It's very important to choose a rhinoplasty specialist to deal with the asymmetries in the nose including the crooked and hanging columella along with the Polly Beak.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Sure. Probably it can be improved. See the morph I made of your photo, and the short video.

Click on the "Web reference" link, just below my response, or go here:

I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.

I elevated that drooping columella. The "columella" is the part of the nose that separates the left nostril from the right nostril. Probably at least some of "the other stuff" that you can live with can be improved further as well. I'd love to hear what you think of the morph. Did it address what you're seeking? The woman in the short video just above also had a hanging columella elevated.

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 "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

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.

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 41 reviews

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.