Follow-up question: 9 months post-op. Is my nose still upturned?

Hello,Only your opinion matters, and if you feel your nose is too upturned (and I agree), then it is too upturned. In addition, the tip is pinched and the columella droops (the skin between the nostrils). Go visit a few open structural rhinoplasty experts. In my hands, you would likely need rib cartilage to lengthen the nose and septum, as well as provide very strong supporting grafts for the tip. 

Hello,Thank you for your question. First you need to finish your recovery process, which is at least one year after the operation. An in person consultation could provide best options for you. Lengthening of the dorsum and septum with the help of a rib cartilage, tip refinement and correcting the nasolabial angle could be helpful in your case. Comparing to the open rhinoplasty Closed and Atraumatic technique in Rhinoplasty minimizes swelling and bruises; maximizes healing, prevents tissue damage and eliminates a scar on the columella. To find out more please click on the attached link.Best Regards

 Revision rhinoplasty for the short nose etc.  Your short nose can be corrected with a septal extension graft and possible composite graphs for the ala. This is to lengthen your short up turned nose. See several very experienced revision rhinoplasty surgeons and show you many revisions in those noses like yours. Do not rely on Imaging but rather results. 

Dear petitegirlok,
Thank you for your question. It is difficult to make an accurate assessment and recommendations based on photographs alone. I recommend you seek a continued regular follow-up with your surgeon who can perform repeat examinations and discuss with you management options to meet your treatment goals. It does appear your nasal tip is more rotated but hard to know if there is residual swelling. If at one year out from surgery you are still unhappy with your results, you could discuss with your surgeon whether revision rhinoplasty may be beneficial. If you and your surgeon are not on the same page, you may consider a second opinion at that point. 

At 9 months out there will not be any significant change in the tip rotation or projection. Much better than photos of others is computer imaging of my patients face when discussing goals for surgery. At this tie you need to consider revision surgery for tip rotation and projection. 

There are many reasons for why a tip would be upturned after rhinoplasty. One reason is that there was perhaps an over-resection of some of the cartilage components of the nose allowing the tip to rotate upwards. It is a difficult maneuver to perform correctly and to avoid secondary breathing issues. Another reason is that this may be the preference or "taste" of your surgeon. Rhinoplasty results need to be discussed during consultation so that you are aware of what your surgeon's taste is and see if it matches with yours. I would give it a full year before trying to revise any work that has already been done. Read about Dr. Panossian's rhinoplasty technique.

I agree. Your nose has been over-shortened and is over-rotated. Lengthening a nose in secondary rhinoplasty requires rigid structural cartilage grafting from either the septum (if available) or rib cartilage. If you are not happy with the outcome then I would suggest you consult with an expert revision rhinoplasty surgeon to discuss your goals. 

Agree that your nose is a little short. An experienced revision rhinoplasty specialist can lengthen you nose if you want.

I personally like to use digital imaging to help make sure the patient and I are on the same page with their desired rhinoplasty results. When performing imaging its important that you take into consideration the patients skin thickness and nasal anatomy so that the morphed or imaged photograph is a realistic proposed result. With that said, every patient has their own idea of their desired nose and its the surgeons job to attain the nose the patient desires not the surgeon. If you look through my hundreds of before and after photographs in my gallery you will see many different shapes and sizes of noses. The patients have consented for the usage of their photographs because they received their desired nose and are happy with their results. One patient may like a more rotated nose, some patients want to keep a slight ethnicity etc..so it is really the patients feelings about their result regardless of what the doctor says. If you do not like your nose then the result in unsatisfactory. In my opinion the nasolabial angle shows a over rotated and over shortened nose which I personally do not find elegant. You may see some slight changes over the coming months but likely not enough to change your opinion. See some examples of before and afters in the link below and see an example of the imaging process including the proposed and final results in the video below. Best regards, Michael V. Elam, M.D.