10 months after my rhinoplasty my tip has drooped and I have a hump again - will I need a revision? (photos)

Question

I had a closed rhinoplasty in April 2022 to remove a hump on my bridge and give my nose a more "up turned" look. I loved the way it turned out and knew some changes would still happen because of swelling and the "final" look would be around 6-9 months. I'm 10 months out now and my tip has drooped and I have a hump again and a dip in the middle of my nose. From the front the tip looks crooked because the right puffs out more than the left. Will I need a revision?

Man Koon Suh, MD · Answer

Thank you for your question. Your nose has a bony bump, there is a deviation in the upper lateral cartilage area, and tip drooping has occurred.All of these can be corrected through revision. Bony bump reduction is not difficult. Upper lateral cartilage deviation can be corrected through dorsal septal correction and spreader graft.Correction of tip drooping requires a more robust structural graft, and other anatomical causes contributing to tip drooping must be found and corrected during surgery.

Steven M. Denenberg, MD · Answer

Your assessment is correct. Your nose is still quite long, with the tip sitting low, and more healing time unfortunately won't cause the tip to come up. In fact, I'd like to see your nose quite a bit shorter than it is right now. The profile view also shows that your nose has strong "projection," meaning it comes out forward strongly away from your face. The good news is that, in expert hands, these two changes, elevating the tip and reducing the projection, are two of the more predictable changes to make, even in a revision. Bonus: making the nose shorter would give a chance of improving the frontal symmetry and making the nose look straighter from the front.
How *much* to elevate the tip, or deproject the nose, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.) I'd love for you to see some excellent morphs of what could possibly be done with your nose. It might make you feel better about the possibilities and help you plan your ideal goal.
Important: remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, like you, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.

William Portuese, MD · Answer

A closed revision rhinoplasty can accomplish shaving down the residual dorsal bony hump, lifting the tip slightly and straightening your nose. Also important to release the depressor septi ligament which dynamically pulls your tip down when smiling. It's important to know how much cartilage is left over on the inside of the nose for grafting purposes, since you'll probably need a spreader graft on the concave (your left) side of the nose. Revision rhinoplasty is more difficult than the primary rhinoplasty, so choose your surgeon very wisely based on extensive experience

10 months after my rhinoplasty my tip has drooped and I have a hump again - will I need a revision? (photos)

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