Realistic expectations from second revision - is it possible to fix the width when smiling? (Photos)

Question

Hi- I had a rhinoplasty about 18 years ago and was unhappy with the scar tissue that made my tip appear bulbous. I was in law school and wanted to get it done quockly so i was an idiot and had a revision with the same surgeon. While the results were okay for awhile, I’ve grown increasingly unhappy with my nose, particularly its width and how it looks when I smile. I’m obviously TERRIFIED to go for Number three and risk a michael jackson situation. My questions are below: 1. Despite the messed up nostrils, im more bothered by the width of the nose than its being crooked. 2. The nose is pulled up and becomes flatter/fatter when i smile and i hate this. 3. Given the above, im not looking for perfection. Would it at all be possible to correct without breaking the nose? 4. What are considerations i should make when chosing a surgeon and what should i ask? Money is not an issue, im more concerned about results and easy recovery (i have three kids)

Gianfranco Frojo, MD · Answer

Not many tertiary rhinoplasties are an easy recovery. There is a lot more swelling and bruising due to more challenging dissection through previous scar/injured tissues.  I would recommend seeing an American Board of Plastic Surgery certified plastic surgeon, preferably one who has also completed an Aesthetic Society endorsed fellowship as well.

Guray Yesiladali, MD, FEBOPRAS · Answer

Hello, after two previous surgeries, your hesitation is completely understandable.
When the main complaint is width, especially that increases during smiling, we must first determine whether the issue is structural or dynamic. Some noses widen because of underlying cartilage shape. Others widen due to muscular pull when smiling. These are two very different problems and require different strategies.
If the widening is primarily dynamic, meaning muscle driven, targeted release or modification of the depressor and alar flare mechanisms may help. If the width is structural, meaning related to cartilage configuration or previous scar contracture, correction usually involves rebuilding support rather than further reduction. In revision cases, narrowing is often achieved through reinforcement and controlled reshaping, not aggressive trimming.
Regarding your concern about “breaking the nose,” not all revisions require osteotomies. If the primary issue is tip width or alar flare, it may be addressed without fracturing the nasal bones. However, if dorsal width contributes significantly, bone work may still be necessary. That decision depends entirely on examination findings.
The most important consideration in a third surgery is structural integrity. The goal is not to make the nose smaller. The goal is to restore balance and stability. Over narrowing in revision cases creates the unnatural, over operated look you fear.
When choosing a surgeon, focus on the following:• Extensive experience in revision rhinoplasty• Demonstrated ability to reconstruct rather than reduce• Comfort with graft based structural rebuilding• A conservative philosophy toward narrowing• Clear communication about limitations and risks
Wishing you clarity and confidence as you consider your next step.
Güler Güray Yeşiladalı, MD

Realistic expectations from second revision - is it possible to fix the width when smiling? (Photos)

Answers (2)

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