I'm uncomfortable with my raised nose tip and exposed nostrils. Should I have a revision rhinoplasty? (Photos)

Question

I’m in my thirties and had a septorhinoplasty with alar batten and spreader grafts (as well as a graft around the tip) because of internal nasal valve collapse, reducing my ability to breath. The rhinoplasty portion was secondary to the functional aspect. I only wanted the dorsum reduced slightly, as I was going under anyhow. I’m happy with my results. Functionally, I’m thrilled but am uncomfortable with my raised nose tip and exposed nostrils. Is it worth a revision? Thanks!

Brian M. Harmych, MD, FACS · Answer

Thank you for sharing your question and photographs. It's not clear how far out from surgery you are based on your photos. Although, it seems like you may be a little early in the healing process. If you are less than one year I would recommend trying to be patient and the tip of the nose may "settle" further. In fact, the tip of the nose may settle a little more beyond one year. Although, how much more settling will happen depends on the amount of current swelling. The issue you are noticing with the nostrils is also likely due to the rotation of the nasal tip. If the tip remains high / over rotated you may consider a revision surgery. As your breathing is doing well, any further nasal surgery would be considered cosmetic and would not be considered functional / insurance. If a revision becomes necessary, rest assured knowing that a surgeon experienced with revision rhinoplasty should be able to offer a high likelihood of obtaining a satisfactory result. Be sure to choose a board certified ENT surgeon, facial plastic surgeon or general plastic surgery that has a lot of experience with revision rhinoplasty surgery if you are even going to consider undergoing revision surgery.

Jonathan Kulbersh, MD · Answer

Thank you for your question and thorough explanation. If your original procedure was at least one year ago, a revision rhinoplasty may be able to lower the nose tip and reduce the appearance of exposed nostrils. You may also benefit from a non-surgical rhinoplasty that uses hyaluronic acid dermal fillers. This injectable treatment may address the upturned nose tip and provide the shape you’re looking for. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your concerns and previous surgical history to come up with the best treatment plan for you.

Ajaya Kashyap, MD · Answer

Thank-you for your question. Your results look good although I can see your concerns. Revision rhinoplasty  could further improve your results. The decision to do a revision rhinoplasty, however, should be made after a thorough discussion with your Plastic surgeon, as there are possible risks with revision procedures.

Barry M. Weintraub, MD, FACS · Answer

As a board certified plastic surgeon who performs numerous revision rhinoplasties, it is important that patients wait until they have fully healed -- particularly in cases such as yours, when the tip height is in question. I do not know how far along you are in the healing process. Ultimately, you are the one who must determine if it’s worth it to consider a revision. Often, patients do not realized the advanced skill set needed to perform revision rhinoplasties. Revision surgeries are more expensive as well. If you have waited 12 months and you’re extremely bothered by your tip, then yes, you can consider revision surgery. Make sure to find a fully qualified, revision-rhinoplasty expert.

I'm uncomfortable with my raised nose tip and exposed nostrils. Should I have a revision rhinoplasty? (Photos)

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