I like everything about my new nose but the tip. Im almost two yearsbmonths post op and I'm not thrilled about the tip. It's very round and sort of droopy. Especially in pictures. At my last follow up, my doctor acknowledged that the skin underneath the nose was a little loose but even with the new procedure, there's a chance it'll still look the same way it does now. He claims there's no way to get rid of the skin. Thoughts?
Answer: Revision rhinoplasty? Dear Arod910I think what you intuitively see, but are not verbalizing, is that your actual tip size for the size of your ala and nostrils is too big. Instead of a 1/3 to 2/3 ratio, its almost a 50/50 ratio. You tip can be made smaller and less projected and its ratio to your ala and rest of nose can be reduced. The complexity of this would depend on what your surgeon did in the first rhinoplasty. If you had shield or tip grafts, then removing that and reshaping your tip can work well, otherwise, its a more difficult and challenging procedure. Providing before pictures would be very helpful.
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Answer: Revision rhinoplasty? Dear Arod910I think what you intuitively see, but are not verbalizing, is that your actual tip size for the size of your ala and nostrils is too big. Instead of a 1/3 to 2/3 ratio, its almost a 50/50 ratio. You tip can be made smaller and less projected and its ratio to your ala and rest of nose can be reduced. The complexity of this would depend on what your surgeon did in the first rhinoplasty. If you had shield or tip grafts, then removing that and reshaping your tip can work well, otherwise, its a more difficult and challenging procedure. Providing before pictures would be very helpful.
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Answer: My comments Your result is very poor and technically faulty, and the repair is very complex and only successful in very skilled hands of the best revision surgeons. This is my analysis of your problems and the solutions:-saddle nose deformity: the supratip is sunken, needs an onlay graft of cartilage to fill it up-pinched dorsum and pinched nasal valves: you need spreader grafts-open roof deformity at the nasal bones associated with hump persistence: you need hump removal and osteotomies or infractures-very bad situation of tip: you need open approach rhinoplasty, direct evaluation of structures and replacing the missing or damaged pieces by new ones custom made and tailored out of cartilage grafts; probably a bit of tip shortening; also tip grafting to obtain a nice and well defined tipAs I mantioned you need to find a very very good surgeon, not a case for a minor retouch at all.
Helpful 1 person found this helpful
Answer: My comments Your result is very poor and technically faulty, and the repair is very complex and only successful in very skilled hands of the best revision surgeons. This is my analysis of your problems and the solutions:-saddle nose deformity: the supratip is sunken, needs an onlay graft of cartilage to fill it up-pinched dorsum and pinched nasal valves: you need spreader grafts-open roof deformity at the nasal bones associated with hump persistence: you need hump removal and osteotomies or infractures-very bad situation of tip: you need open approach rhinoplasty, direct evaluation of structures and replacing the missing or damaged pieces by new ones custom made and tailored out of cartilage grafts; probably a bit of tip shortening; also tip grafting to obtain a nice and well defined tipAs I mantioned you need to find a very very good surgeon, not a case for a minor retouch at all.
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July 24, 2015
Answer: Revision rhinoplasty decision I like your nose too! You look good. It is always tough to make decisions or advise people through photographs. As you know, there can be great variation from one photo to the next in how structures appear. That said, I think you are referring to the shape of the tip in the region of the infratip lobule down to the columella? If so, then it is likely this can be improved, and it may not be related to the skin, but rather to the cartilage. Think this through carefully after getting more than one opinion. I hope this helps you, and I wish you the best of luck.
Helpful 1 person found this helpful
July 24, 2015
Answer: Revision rhinoplasty decision I like your nose too! You look good. It is always tough to make decisions or advise people through photographs. As you know, there can be great variation from one photo to the next in how structures appear. That said, I think you are referring to the shape of the tip in the region of the infratip lobule down to the columella? If so, then it is likely this can be improved, and it may not be related to the skin, but rather to the cartilage. Think this through carefully after getting more than one opinion. I hope this helps you, and I wish you the best of luck.
Helpful 1 person found this helpful
July 24, 2015
Answer: Revision rhinoplasty and chin implant candidate When contemplating a revision rhinoplasty, it's very important to have specific goals in mind on what you would like to accomplish with the procedure. Revision rhinoplasty as one of the hardest operations to perform correctly in the entire field of cosmetic surgery, so choose your rhinoplasty surgeon based on experience. The photographs do not demonstrate a droopy tip. There is a recessive chin profile present for which a chin implant could help out the overly projecting nose and improve the facial profile to help with facial balance and proportions
Helpful 1 person found this helpful
July 24, 2015
Answer: Revision rhinoplasty and chin implant candidate When contemplating a revision rhinoplasty, it's very important to have specific goals in mind on what you would like to accomplish with the procedure. Revision rhinoplasty as one of the hardest operations to perform correctly in the entire field of cosmetic surgery, so choose your rhinoplasty surgeon based on experience. The photographs do not demonstrate a droopy tip. There is a recessive chin profile present for which a chin implant could help out the overly projecting nose and improve the facial profile to help with facial balance and proportions
Helpful 1 person found this helpful
July 24, 2015
Answer: Revision Rhinoplasty There are several features that are quite nice. The sweep of the bridge off the base of the nose to the tip, the length of the nose, and the symmetry. It would be good to see the original photos as the current appearance can be quite an accomplishment. Having mentioned this, you have what seems to be features of the ball tip, where the tip cartilages are clumped together and upward. This can cause the nostrils to appear collapsed. An approach exclusively at the rims of the nostrils, delivering the clumped cartilages, and then rotating them out into a gull wing shape across the roof of each nostril iwould reduce the ball, and provide more nostril support to the sides. This procedure called cartilage delivery is designed for such problems. It helps shape and reposition tip cartilages and may include trimming or just a different rotation. For your surgeon who has created a nice tip angle, he or she may feel the risk for this type refinement might be too high against any benefit, especially if the achievement from your preop appearance has been compelling. We perform cartilage delivery in patients with a ball or parentheses tip. Sometimes the tip droops a bit and some cartilage may need to be placed in the central area called the columella at the conclusion of the procedure. The floor of the nostrils may also have to be reduced in a few patients as well. This is a complex type of revision but not uncommonly performed. You can google cartilage delivery for ball tip nasal issues.
Helpful
July 24, 2015
Answer: Revision Rhinoplasty There are several features that are quite nice. The sweep of the bridge off the base of the nose to the tip, the length of the nose, and the symmetry. It would be good to see the original photos as the current appearance can be quite an accomplishment. Having mentioned this, you have what seems to be features of the ball tip, where the tip cartilages are clumped together and upward. This can cause the nostrils to appear collapsed. An approach exclusively at the rims of the nostrils, delivering the clumped cartilages, and then rotating them out into a gull wing shape across the roof of each nostril iwould reduce the ball, and provide more nostril support to the sides. This procedure called cartilage delivery is designed for such problems. It helps shape and reposition tip cartilages and may include trimming or just a different rotation. For your surgeon who has created a nice tip angle, he or she may feel the risk for this type refinement might be too high against any benefit, especially if the achievement from your preop appearance has been compelling. We perform cartilage delivery in patients with a ball or parentheses tip. Sometimes the tip droops a bit and some cartilage may need to be placed in the central area called the columella at the conclusion of the procedure. The floor of the nostrils may also have to be reduced in a few patients as well. This is a complex type of revision but not uncommonly performed. You can google cartilage delivery for ball tip nasal issues.
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