How to shorten a bottom heavy nose? (photos)

Question

I have had a previous rhinoplasty a year ago to rotate tip (strut), remove hump, and trim the caudal septum. My nose is still very very bottom heavy and there is no space between the bottom of my caudal septum and upper lip. What are some ways to extend the space? I feel a trim will solve a 2 or 3mm issue. This seems like 5mm+ where a trim wouldn’t solve raising the base near the spine.

Philip J. Miller, MD, FACS · Answer

This needs an in-person evaluation. There are often an assortment of reasons that patients are unhappy with their initial nose job. Revision rhinoplasty is an option to address these issues of concern.
When performing revision rhinoplasty or a secondary nose job, it may be necessary to employ an open rhinoplasty surgical technique which entails placing an incision across the columella (skin between the nostrils). This surgical technique allows for a facial plastic surgeon to have improved clarity. Subsequently, for my patients this allows me to better see and approach the problem.
The best piece of advice I can give you is to seek out a revision rhinoplasty specialist that is board certified in facial plastic surgery. A rhinoplasty done in the hands of an inexperienced surgery takes longer and you may be able to speak better to this than most others, often leaves you with an undesirable result. Do your research and go on a few consultations. The more unified your vision is with your surgeon, the better your end result will be. I wish you the best on your journey toward fixing your nose. 
Sincerely,
Philip J. Miller, MD, FACS
Double Board Certified Facial Plastic Surgeon

Thomas A. Mustoe, MD, FACS · Answer

Your goal is a challenging one.  Your tip  is very projecti g and you still have a prominent columella.  Reducing tip projection which I often do will also make it easy to reduce tissue in columella and that combination should help a great deal.  The revision does not require osteotimies but would require a formal revision rhinoplasty.

Suleyman Tas, MD, FEBOPRAS · Answer

Hello,Thank you for your provided photos,After completing one year healing process, according to the final result.A failed rhinoplasty can be imroved for a better, well proportioned nose by Closed and Atraumatic Rhinoplasty you will have maximal healing with minimal tissue damage.Regards,

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