Open rhinoplasty 8 months - revision needed? (Photo)

Question

I had open rhinoplasty in February 2024 (8 months ago) and would appreciate your advice on the outcome. While my breathing has improved, I am not satisfied with the aesthetics, especially the frontal view. The tip still looks too large, more than before surgery ( I have thick skin). My surgeon mentioned supratip fibrosis but feels his work is excellent and last time proposed a filler on the bridge to make it more even. I think the nose would look bigger. Shoulf i consider revision? Thank you

Eric M. Joseph, MD · Answer

I say this because I agree that you appear to have thick nasal skin, and I believe you will continue to see narrowing of your nasal tip as time moves forward. If you nasal appearance is still bothering you after four months, please consider meeting with another reputable rhinoplasty specialist to get a second opinion. Revision rhinoplasty would not change the thickness of your nasal tip skin, and cartilage grafting may be necessary to achieve a significantly narrowed appearance. I hope this helps, and I wish you well moving forward. Sincerely, Dr. Joseph

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can understand from your question In thick skins, it may take 2 years for the nose to take its full shape, at least after 1.5 years, a re-evaluation can be made.
It would be better face to face consultation.
Best Regards!

Gary M. Horndeski, MD · Answer

Your tip does look a little wider. However, it is only 8 months and I recommend waiting a full year before doing an revision. You will need a tip revision to redefine the tip more. I would not recommend filler on the bridge.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Mark K. Markarian, MD, MSPH, FACS · Answer

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

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. 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

Best wishes and good luck.

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

Nicholas Lahar, MD · Answer

Hi Silvia, tjhanks for your question. In general it is a good idea to wait at least a year to make a decision to have a revision. Before that time, there is swelling that will cloud the "real picture" of what is happening. I do see what you mean about the tip but this could be the swelling, scar tissue that is developing, and/or thick nasal skin. Interventions include watching and waiting, steroid injection to the scar tissue, or revision surgery. Stay in close contact with your surgeon at the year mark to see what the next steps should be.

Mats Hagstrom, MD (license on probation) · Answer

I think doing rhinoplasty in your case was a bit of a challenging case.
You started with quite an obtuse nasolabial angle Which is now even more open.
Your nose also had very strong projection which might’ve created some challenge.
At this point your best bet is to continue following up with your surgeon.
Most plastic surgeons will not do rhinoplasty revisions within the first 12 months.
If you want the proper second opinion consultation, I suggest you schedule those as in person consultations with other plastic surgeons in your community.
For second opinion consultations come prepared bring with you a complete set of proper before and after pictures and a copy of your operative report.
These are all part of your medical record that you can request from your current providers office.
 It would be very important for us to know exactly what was done during your first rhinoplasty in order to understand the outcome and help decide what could be done as a secondary procedure.
I generally don’t like to make any definitive recommendation without having complete information.
Best,
Mats Hagstrom MD

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