Rhinoplasty or Revision Rhinoplasty? What would you recommend to fix the bulbous, droopy tip?

Based on your photo, you are a great candidate for rhinoplasty. During septoplasty and "graft placement," the support to the tip is not often taken into consideration unless the procedure is done by a rhinoplasty expert. In the revision, the droopy tip can be lifted and strengthened, as well as thinned out at the same time. But this has to be done by someone that specialized in rhinoplasty surgery and does it regularly.

The fact that you had a "caritlage graft" means that you had a rhinoplasty, so yes, if you get more work done, it would technically be considered a revision rhinoplasty. Also you had a septo, which is important for your surgeon to know because that means you likely don't have enough cartilage in your nose to use for a rhino. The things you are bothered by do seem like things that can be addressed; consult with a surgeon abotu them.

If I had to guess, you may have had a spreader graft placed on the left side, since preoperatively you appear to have an indentation along the left side wall of your nose. We can also see from your photographs that you have thin nasal skin, with a droopy tip appearance, and a dorsal hump. The complexity of your surgery would require an examination. That regard, your fee would be closer to a primary rhinoplasty fee, if there is a relatively uncomplicated situation to repair. Consider meeting with several reputable rhinoplasty specialists since one more operation would be the time to get it right. Thank you so much for your question. Sincerely, Dr Joseph

More than a revision, I believe it is a close to primary rhinoplasty scenario, any grafting applied is minimally perceivable (if any); nostril asymmetry is not fixable and is a natural issue in all human faces, we all have one hemi half of face asymmetrical to the other one, affecting brows, eyes, cheekbones, lips, smile, nose, chin, etc.

However, at your nostrils there is a issue needing specific technical emphasys, it is the high grade nostril retracion due the poor alar support, making your nostrils look overly large and the columella exposed (columellar show). Also, you have a type of dorsal hump that is rhomboid and pandorsal, this is another very very specific issue which deserves one well-known and rarely mastered method to turn that rhombus into the parallel "railway tracks" a dorsum should look like.

Find advice with solid structure rhinoplasty surgeons.

"cartilage grafting to prevent nostril collapse" involves modification of the areas on or adjacent to the tip cartilages, and that generally does complicate the next operation, sort of like a previous rhinoplasty complicates the next one, but hopefully not nearly as significantly. In the before and after you posted, the tip seemed to be droopy in the before, and it seems quite a bit wider in the after, and still droopy. Frankly, I don't love functional operations with grafting that will significantly change what the nose looks like when they're done without considering or addressing what the patient wants the nose to look like ideally. They also don't routinely work well enough on the nose's function to possibly make the risk reasonable.

Anyway, what you would do now is figure out how your nose looks different from what you want it to look like, and find a surgeon who feels he can address those changes. Morphs are very important, so you can fine-tune the goal, and you can see whether the surgeon has in mind the same changes that you might be describing verbally.

Hello and thank you for your question. Based on your, you may benefit from a revision rhinoplasty. A surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. Nostril symmetry can also be improved. 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