Tip still very bulbous one year post rhino - what can I do?

Question

I’m a nearly 30 year old Caucasian female. Exactly a year ago, I had a rhinoplasty . Though the side profile has improved, my nose is now THICKER from the front angle than it was before. And the tip is still bulbous. My surgeon did a lipodissolve shot, but that hasn’t made it less thick & bulbous. What to do?

Eric M. Joseph, MD · Answer

In general, if someone has Caucasian skin and a wider nasal appearance after rhinoplasty surgery, revision rhinoplasty surgery may be considered. You may be able to get a more comprehensive answer from the experts if you really ask a question with photographs. Thank you. Sincerely, Dr. Joseph

Gianfranco Frojo, MD · Answer

I would wait for a full year after the original surgery; maybe even 18 months. If you are not confident that your surgeon can potentially provide a reasonable option to achieve the goal you are seeking....sometimes it helps to seek a second opinion from a rhinoplasty specialist. I always recommend finding someone certified by the American Board of Plastic Surgery.

Steven M. Denenberg, MD · Answer

Of course it's impossible to say without seeing photos, but the most likely cause is inadequate work on the tip cartilages, and a revision might get you closer to your goal. I don't know what the deal is with the lipodissolve shot: I've never heard of it before, and there's no fat in the tip of the nose to dissolve. It makes me suspicious that you should get an opinion of what's going on from a revision expert. If indeed your operation wasn't expertly performed and revising the tip cartilages can help lots, that would be the best case for you. If it's all just excess skin width and scar tissues, that's less predictable to fix.

Finally, 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. From what you describe, the changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. 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 it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. The final results take at least 1.5 years for the swelling to fully resolve. This can require lots of patience and waiting. Steroid injections performed by your surgeon can be extremely helpful. I usually start steroid injections around 1 to 2 months after surgery and continue as needed. I recommend that you maintain close follow up with your surgeon who can evaluate you in person. If it turns out not to be swelling, and your surgeon is not able to help you then I would recommend seeking secondary consultations.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Samuel Lin, MD, FACS · Answer

Thank you for your question. In cases when the skin appears thicker I would want to know some of the original goals of the rhinoplasty and understand those aspects before moving forward with any additional treatment ..

Tip still very bulbous one year post rhino - what can I do?

Answers (5)

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