Can I add a small bump back and make my nose look thinner, tip more projected? (over 9 months post op). (photos)

I wrote 'before' and 'after' under the photos, so you can tell which is which. I posted earlier on, but I think I have an inverted V deformity. There are also spreader grafts in my nose. My nostrils seems wider than before, and my tip looks like it lacks projection. Will adding cartilage to the tip look fake? I want the front of my nose to be closer to how it was before. I don't care what the side profile looks like anymore. I'd add the bump back to make the bridge less flat. Thank you

Doctor Answers 3


Dear m0kat, I recall many of your other posts from many months ago when you were still in the early recovery phase. Unfortunately your concerns at that time have been warranted by your current result. I really believe at this time since there are multiple issues that need addressing with revision surgery that you request a copy of your operative report and pre-operative photographs from your original surgeon and seek consultation with some experts in the field. I would suggest that you really take your time with this process and discuss all of your concerns and make sure you have a full understanding of the techniques that need to be used to provide you with a nose closer to your pre-operative photographs. In my practice especially with a patient like yourself less is always more. You needed some small refinements that should have been easy to provide without all of  the grafting and other techniques used. As shown in the video above small refinements to the nose to enhance a patients facial aesthetics do not need to be over complicated. Best regards, Michael V. Elam, M.D.

Orange County Facial Plastic Surgeon
5.0 out of 5 stars 196 reviews

Somewhat over-resected closed rhinoplasty

It appears that you have had a closed rhinoplasty with a rasped down dorsum and resected tip appear to be a good candidate for a revision rhinoplasty... your  over-resected dorsum resulted in a classic 'inverted V' deformity eliminating your dorsal lines which were better pre-op .... you have lost tip structure as well....all distracting from otherwise attractive facial features it appears that you would benefit from structural grafting which would likely include bilateral spreader grafting (to correct inverted V, restore dorsum and dorsal lines), columellar strut grafting (restore tip projection) and possible alar rim grafting...The decision to undergo a revision rhinoplasty needs to be considered carefully ..Unfortunately, unsatisfactory results and secondary deformities from primary rhinoplasty are common.... like many other advances in science and technology, the techniques and approaches to rhinoplasty have become significantly refined over the last 20 years..... much of what is done now by qualified rhinoplasty specialists is much more 'constructive' than the 'destructive' methods of the past.... still many patients have suboptimal surgeries that result in asymmetry, over-resection of supporting structures and ultimate collapse over time. There are rhinoplasty 'experts' out there.... now your work begins...unfortunately many plastic surgeons who hold themselves out as rhinoplasty experts are not...You need a thorough evaluation and a well thought out will need to gain the confidence that your surgeon has the skills and aesthetic judgment to fix your will need to see several doctors to become convinced of what an actual expert is...find out who OR nurses and doctors go to and who their family/friends go to.... do your homework and be sure that your revision rhinoplasty surgeon has: 1. many years of rhinoplasty practice experience
2. judgment and techniques that have evolved over time
3. a practice focused on rhinoplasty 
4. a willingness to do difficult, secondary and reconstructive cases
5. an interest in teaching others how to evaluate and do rhinoplasty properly
6. a willingness to share rhinoplasty resume, photos and patient experiences with prospective patients good luck...

Dissatisfied 9 Months after Rhinoplasty

I'm sorry you did not achieve the desired result. With your multiple problems and concerns I suggest you discuss these issues with your surgeon and/or consult with a revision rhinoplasty specialist.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.