Open rhinoplasty 8 months - revision needed? (Photo)

Hello and thank you for your question. Although an exam in person is ideal, from your photographs alone, I agree that you have some residual supra-tip fullness, with possible tip over-rotation.

The simple answer is to "subtract", and not "add".

What do I mean by this?

To improve your profile view, I think you would benefit from reducing the mid-vault/supratip area (above the tip) and not add to the bridge with filler. I perform steroid injections postoperatively in all my patients, specifically in that supratip area, as early as 1 month postop at times. This may improve that fullness or "fibrosis" your surgeon discussed. I would ask you to discuss this with your surgeon as an option. At 8 months postop, this may still help. Moreover, your tip may also de-rotate some over the next few months (which would help the over-rotation) but unlikely if certain maneuvers were utilized in your surgery.

If you are unhappy at 12-18 months postop, I think a revision rhinoplasty is the only option to adequately address your concerns. If you're unhappy with the supratip fullness and tip position at that time, I would recommend a reduction of the mid vault profile (above the tip), with tip deprojection, and tip de-rotation. As your septal cartilage is likely harvested at this point (in the original rhinoplasty), I would utilize MTF (Musculoskeletal Transplant Foundation aka cadaver) cartilage to fashion cartilage grafts for this surgery. Specific maneuvers/grafts would include extended spreader grafts, tip deprojection with medial crural resection secured to a columellar strut, and extended alar grafts. Please discuss all this with your rhinoplasty surgeon.

Hope this helps. For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

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. The width of your tip should improve with time. What will not improve is the notching of your soft triangles. That will likely only get worse with time and may ultimately be a reason for a revision. I recommend that you maintain close follow up with your 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