What is wrong with my nose? How can it be fixed? (Photo)

Question

I had a rhinoplasty 6 months ago (deviated septum, dorsal hump, big droopy tip). Looked great straight after, but 2 months post op a supratip bump appeared. Since then everything has gone progressively worse. Got a microdose of cortisone at 4 months post op but did not help. The bump is rock hard and very protruding, there is an indented area above it (visble from sides) and the bridge is uneven. What could be wrong and how can it be fixed? Surgeon wants to do a revision at 9 months post op.

Eric M. Joseph, MD · Answer

A polybeak is when the lower dorsal septum protrudes from the face further than the nasal tip. I suspect this may be the case since you describe it as feeling firm. If this will require revision rhinoplasty surgery, please consult with several reputable rhinoplasty specialists so you can see what might be best for you moving forward. Wishing you well. Sincerely, Dr Joseph

Steven M. Denenberg, MD · Answer

If the bump feels very hard, it's probably cartilage, and it's probably not going to go away with a cortisone shot, as it sounds you've already discovered. The frontal views seem to show that depression between the hard bump and the bones farther up the nose. The middle image shows prominence of the tip, then the bump, then the depression, then the prominence of the bones. The bones have the appearance of an "open roof" deformity, which is common when a bump is removed from the bridge but the bones aren't then narrowed in position to maintain a nice triangular contour to the upper nose. You'll probably end up having to decide whether to live with this nose or get a revision. If you do opt for a revision, look at all the areas of your nose as well, because you would want the surgeon to address everything that's not to your liking.

How *much* to lower that bump, or narrow the bones, or make other changes, such as further changes to the tip? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Timothy Osborn, MD · Answer

Rhinoplasties have one of the highest revision rates out of all cosmetic procedures, and I will say that with every revision, the surgery becomes more difficult. I would recommend seeing another rhinoplasty specialist in the area for a second opinion before having a revision with the same surgeon. After your surgery, did your doctor have you tape your nose, or massage the tip after the initial healing phase? Has your breathing been effected at all? Cosmetically there are things that can be done to improve the appearance of your nose, but more importantly is your ability to breathe well. We offer virtual or in-person consultations if you would like to discuss things further!

Dean Toriumi, MD · Answer

Thanks for the question and the pictures. Based on your pictures, it looks like you have lost some of the support in the bridge of your nose that is normally supported by cartilage. In order to resolve this issue, you will need a revision rhinoplasty and will require replacement of the structure of your nose. Hope this answer helps, good luck on your journey.

What is wrong with my nose? How can it be fixed? (Photo)

Answers (4)

Answer: Postop nasal deformity

Answer: Postop nasal deformity

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

What is wrong with my nose? How can it be fixed? (Photo)

Answers (4)

Answer: Postop nasal deformity

Answer: Postop nasal deformity

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.