Unhappy! 6 Months Post-Op Rhinoplasty. Side profile changed, pinched in tip. (photos)

Question

I am unhappy with my post-op results ESPECIALLY with my profile. I liked my profile before, now it looks terrible: tip protrudes, looks like my bridge has been scooped out. I did not ask for the structure of my side profile to be changed!! I wanted my tip reshaped to be smaller, and nostrils as well especially from the front but now it looks pinched in and shapeless, almost like an "MJ" effect especially when I smile. Any insight? Should I be patient? Should I require revision?

Toby Mayer, MD · Answer

Normally we wait one year for final healing. However if your nose is indeed scooped out and will require revision. The dorsum will have to be augmented because  your nose bridge looked better preoperatively  and will need grafting from the septum or ear to repair this. See a very experienced revision rhinoplasty surgeon if you do not have confidence in your primary surgeon.

P. Daniel Ward, MD · Answer

Your profile has certainly changed.  In general, it is most appropriate to wait at least a year for any revision nasal surgery; however, in this case, I think earlier surgery could be considered.  You have lost the appropriate height of your nasal dorsum.  You will need to have this replaced with cartilage from either your septum, your ear, or your rib.  In addition to the profile changes, the frontal view of your nose would also benefit from revision to better define the tip.  Be sure to talk to an experienced rhinoplasty surgeon who can help minimize the risks associated with revision surgery.

Stephen Prendiville, MD · Answer

Although I generally counsel patients to wait at least a year before seeking revision Rhinoplasty, there are certain aspects of the nose shown which will not improve in this time frame.  The photos show a middle vault collapse, or what we as Rhinoplasty Surgeons describe as a saddle nose deformity.  This draws attention to your nasal tip, which does appear more refined than the preoperative photo.  If you are unhappy with your current appearance, you will need to have a revision.  Refine your search based on experience and results over price.

Brian J. Reagan, MD · Answer

Yes, the dorsum of your nose appears over-reduced.  A temporary solution would be injection with a filler.  I prefer a hyaluronic acid at first since it can dissolved if you don't like it.  Ultimately a revision may be necessary.  Rhinoplasty revision rates with a good surgeon is atleast 5-10 %.  Discuss with your surgeon.

Michael T. Somenek, MD · Answer

At 6 months postop, there is still healing that is going to occur. That being said, I do see your concerns on your profile and frontal views. It appears that some of the dorsum was resected while further projecting your nasal tip creating a discontinuity between the two. These features are unlikely to change that much in the coming months. The pinched tip may be due to over resection of the lower lateral cartilages, scarring, or excessive narrowing of  with sutures. I would recommend following up with your rhinoplasty surgeon so they can evaluate your nose and determine if there is anything to be done. If you feel like your concerns are not being addressed then it is always acceptable to seek a second opinion. Best of luck to you.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the photo and question and I agree that your dorsim appears scooped out and I would bring your concerns to the attention of your surgeonDr Corbin

Richard W. Fleming, MD (retired) · Answer

Although I typically recommend waiting about one year for a revision rhinoplasty you can start to consider a revision which which I would recommend. You do have a scooped out profile, a poorly defined tip with collapse of the tip above the nostrils. I suspect that you probably have some breathing obstruction. You will need a revision; the only question is timing which can be determined after examination.

Michael Elam, MD (retired) · Answer

Dear fga13, Unfortunately, you will need a revision surgery to repair your "saddle nose deformity." This middle collapse has caused the step between the dorsum and the tip. It is advised to wait a full year for revision surgery. However, with that said, time will not improve this complication and it will require a revision procedure. Discuss your concerns with your surgeon and then move forward from there. Best regards, Michael V. Elam, M.D.

Unhappy! 6 Months Post-Op Rhinoplasty. Side profile changed, pinched in tip. (photos)

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