Deviated septum and extremely hard tip with two points, 10 years post op - can this be fixed? (Photo)

Based on your photo, you are a good candidate for revision rhinoplasty. The hard tip cartilage pieces can be softened while giving your nose on overall nicer shape, while keeping it looking natural. Be sure to see a rhinoplasty expert for consultation.

Hello! Thank you for your question.
As far as I can see from your photos Comprehensive Revision Septorhinoplasty is the appropriate surgical approach to address the structural, aesthetic, and functional deficits. A consultation with a specialized revision rhinoplasty surgeon is strongly recommended.
It would be better face to face consultation.
Best Regards!

There are indeed ways to soften sharp edges of cartilages, but some of those techniques have a tendency to change the *position* of the tip, too. So it's important to determine whether, ideally, you might want that position changed as well -- for example, is it okay if the tip is brought back a little closer to your face. Profile views would help with that determination.

Changing the pointiness of cartilage edges is not an easy slam dunk, especially if we want to leave the tip's position exactly as it is. A common technique would be to steal some cartilage from your septum and nestle it around the pointy edges, but that doesn't always work as well as we like. Sometimes it's safe to actually modify the tip cartilages themselves. And there are other techniques to soften the edges -- like covering them in fascia, for example -- that would make the tip of your nose *bigger*, and to my eye that would be awful.

Also, you have a startlingly gorgeous facial structure, so you can't take the risk that something is going to change about your nose that would draw unwanted attention to a new unwanted feature of the nose caused by the revision. That's what I meant about taking great care -- you should only have surgery if the surgical plan has a good chance of *meaningful* success (not just a tiny tweak), and a *minimal* chance of making things worse, which can always happen with a revision. You should always remember that doing nothing is a totally acceptable option.

If the septum is still a problem, it could be addressed at the same time. The runny nose, frankly, can be hard to fix. Sometimes there are clues to what's going on when I look inside the nose, but surgically changing the structure to make a runny nose stop is not a predictable cause-and-effect change that we're any good at in general.

Hello and thank you for your question. Based on your photograph, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, 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