I had a revision rhinoplasty 4 years ago, and still have a big tip and droopy nose. I am very upset. (Photos)

I had a revision rhinoplasty 4 years ago and the tip of my nose is still too big, and a bit droopy. I want to know if it's still possible for my nose to heal at this stage or will I have to find another surgeon to correct this. I really need your input. Thank you

Doctor Answers 10

It won't change on its own now. Sorry. See my morph.

Click on the "Web reference" link, just below my response. I made a couple of computer morphs of your nose, and animations of the morphs, to show the changes that are possible for your nose in truly expert hands.

I simulated elevating the tip, tucking up the columella (which is the piece that separates the left nostril from the right), straightening out the bridge, and importantly, lowering the height of the bridge up high, where your nose begins, in front of your eyes.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

The good news for your nose is that these changes -- especially raising the tip -- are fairly predictable to make in expert hands, even in a revision.

Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.

Omaha Facial Plastic Surgeon
4.8 out of 5 stars 41 reviews

I had a revision rhinoplasty 4 years ago, and still have a big tip and droopy nose.

You will need a 2nd ?? revision. Choose a surgeon with experience. Bring your op reports, 1st pre-op photos and any interim photos with you. Choose a surgeon who does computer imaging so that you both understand the goals of the procedure.

Curtis Perry, MD
Downey Facial Plastic Surgeon
4.8 out of 5 stars 19 reviews

Rhinoplasty revision

Your best bet is to have the supratip area (this is the area just above your tip) be shaved down so that your nasal dorsum extends lower close to your tip. this can easily be done using a closed rhinoplasty. Morphing can be used to show you this.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 68 reviews

Revision rhinoplasty

Your nose will not change further at this point.  You will need yet another revision.  The tip should be thinner but may be limited somewhat by scarring of the tip skin.  Regardless, the twist and the hanging columella should be improved.  Seek out an expert in revisions.  Best wishes.

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 16 reviews

Revision Rhinoplasty 4 Years Later

Unfortunately, your nose is not likely to change much more nearly 4 years after the revision rhinoplasty. Looking at the photos provided, it appears you will need a second revision procedure in order to address the shape and size of your nose. Look for a surgeon who has truly dedicated experience in revision rhinoplasty surgery along with an extensive gallery of patient examples that reflects their past work. 

John M. Hilinski, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

Revision rhinoplasty candidate

After four years, the nose is not likely to change anymore from where it currently is. A tertiary rhinoplasty is very difficult, so it's important to know what was performed on the first two rhinoplasty procedures to get an understanding of where you can go from this point. Best to obtain your old operative records, if possible. Depending upon what was done in the past, the tip can be refined, the hanging columella reduced, the tip of the nose lifted, and the supratip depression augmented. For more information and many examples of  revision rhinoplasty, please see the link and video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Not Satisfied with Big Tip and Droopy Nose 4 Years after Revision Rhinoplasty

Now that you've waited 4 years your nose will not change significantly in the future. The pictures do show a wide asymmetrical tip and a hanging columella. Consult with your surgeon or another revision rhinoplasty specialist.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Revision rhinoplasty for the unsatisfactory result.

Revision rhinoplasty for the unsatisfactory result. Unfortunately you need a revision done by a very experienced revision rhinoplasty surgeon to correct this. Look at the results of the surgeons revision and choose one whose results u like. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Revision Rhinoplasty Considerations

thanks for your post. I am sorry that your revision rhinoplasty result did not turn out as you had hoped. I agree that there may be room for improvement through advanced revision rhinoplasty techniques. In general, further observation after 4 years will not likely demonstrate any significant improvement. I would discuss your concerns with your surgeon or get another opinion from an experienced revision rhinoplasty specialist on how to best proceed. 

Fred J. Bressler, MD, FACS
Houston Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Improvement Is Possible

Hi Val0808,

Thanks for your question and related photos.  Based on your short history and what I can see, I believe your nose can be improved upon. It is normal to feel that it may be hopeless after you have gone through more than one surgery and did not get the results you desire.  However, in the hands of a surgeon who does a lot of complex secondary (revision) rhinoplasty, your chances are very good.  Because I do a lot of this type of corrective work, I am comfortable with your nose.

You do appear to have a complex columella and tip problem, which would likely require grafting of septal, ear or rib cartilage (depending on what is available) as well as making the aesthetic changes you desire.  Keep in mind that there is no substitute for an in person examination and discussion.

I hope this helps!  I wish you all the best.

Paul K. Holden, MD

Paul K. Holden, MD
Phoenix Facial Plastic Surgeon
4.9 out of 5 stars 52 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.