11 months post op Revision Rhinoplasty, the entire tip looks piggy and has no definition. Any suggestions? (photos)

Eleven months ago I had revision Rhinoplasty. My septum was deviated, since surgery one nostril is literally pointing downwards where the other one kind of looks normal. The entire tip looks piggy kind and does not show definition especially not at tip. When I smile it looks really bad the tip swings open to the sides. I am very, very frustrated and unhappy. I had the best Dr what can I do to make a change? I appreciate all suggestions very much. Thank you

Doctor Answers 2

Revision rhinoplasty with cartilage grafting can help reposition your nose to reduce the piggy appearance.

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Hello Mirja,
Thanks for your question.  I'm sorry that you are disappointed with your outcome.  At 11 months postop, your nose is probably completely healed and won't be undergoing much more change.  For what it's worth, I think your nasal tip at rest looks good.  Your base width seems out of proportion though.  When I perform revision rhinoplasty, I won't touch a nose unless it is 12 months postop.  You will find that this is typical of most revision rhinoplasty specialists.
Looking at the views that you provided, it seems that your tip is centered and narrowed, but it is over rotated and the columella was left hanging or exposed.  Profile views would be helpful, though, to better evaluate your concerns.  
When a patient with a problem like yours comes into my office my plan would typically be open rhinoplasty with scar removal, then extended spreader grafts to de-rotate the tip, and columellar strut grafting to keep the tip centered with smiling.  I think that a columellar lifting procedure would help.  You could add alar base narrowing procedures to improve the proportionality of your nasal dimensions.  
The most important thing to understand before you try to improve this result is that the chances of failure or a suboptimal change are higher in revision rhinoplasty.  Seek out specialists in revision rhinoplasty and go on several consult visits to make sure you are comfortable with their particular surgical plan.
Good luck,
Dr. Shah

Revision rhinoplasty can improve the nose

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The goal of revision surgery is to improve the nose.  After previous surgery the nose may have scar tissue. This may limit the results that can be achieved with a revision procedure.

Robert Mounsey, MD
Toronto Facial Plastic Surgeon

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.