Risks of Revision Rhinoplasty - could this be improved with a minimal procedure? (Photos)

It's totally true that a nose can get longer with time -- gravity gets to it like gravity gets to everything else. However, I can't tell how long your nose is right now, because the bottom of your nose is cropped off in all these photos. The fourth photo does indeed seem to show that it's *very* long with smiling, because the tip almost touches your lip. I'll just bet that the at-rest photos also show a nose that you might like to have shortened.
Elevating a tip, in expert hands, is one of the more predictable changes to make in a rhinoplasty, even a revision. It should be possible to soften that dent as well, probably with some grafting to fill it in.

How *much* to elevate the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that revision rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery.

If you would be satisfied with nostril lowering, and filling in of the indentation along your left nasal sidewall, microdroplet Silikon-1000 injections maybe considered for permanent non-surgical nose job treatments as an alternative to revision surgery. I hope this helps! Sincerely, Dr Joseph

Hello and thank you for your question. Based on your photograph, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, correction of alar retraction, correction of mid-vault asymmetry, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Unfortunately I only envision a full-blown revision rhinoplasty as option for you, any minor or smaller procedure would lead to disappointing or even worse aesthetic results.

Do consider these technical and structural problems in your nose as key goals to address:
-hyperdinamic smile making you flare a lot the nostrils, easy to solve severing the levator alaque nasi muscle
-very bad alar rim retraction because of poorly managed support there, this leads to chain of issies: columellar show, enlargened nostrils, poor breathin intake
-poor tip support helps for your angled tip when smiling
-you have touched the most important problem; to start with you have an open roof deformity allowing the septal ridge to protrude and be visile, leaving slots at its both sides between the septal crest and the nasal bones, this happened because you did not get efficient osteotomies (mandatory!); well, on top of this it seems to me, unless and optical effect is bisasing my judgment, the surgeon did shave or file down the nasal bones, I say such because I perceive the top of the nasal bones lower than the top of the septal ridge, and this can be only due to a surgical shaving of the bones, making them unlevelled with the septum; this problem has difficult solution and is open to 2-3 technical options to be discussed with you; one is filing down the septum to level it with the bones (and then close the roof with osteotomies), but this option would leave a small nose (not sure if you want this) or even a little scooped dorsum; another approach would be masking the gap with thin temporalis fascia (superficial one) grafting, after doing the osteotomies of course; both have pros and cons
-the tip is too high, I bet the surgeon did trimming of the angle of the caudal septum, this maneuver rotates the domes without rotating the columella, which is your feature now

As you may understand, we are facing a complex revision rhinoplasty without any other workaround, substitute, placebo o partial solution acceptable, it may take 5-7 hours and need a multitude of techniques, fine skills, varied grafting, etc; is this beyond feasible? of course not, it is totally feasible, just only for the right professionals.

You're right that some revisions are calamitous, happens when the surgeon is not skilled and passionate for this ultra-challenging field of plastic surgery, may surgeons promote themselves as proficcient, maybe their credentials support their work but not their talent (personally, I'd never be able to play the fiddle properly, no matter my credentials), yet with the risk of a poor revisional work... getting a small procedure is guarantee of much worse outcome. In rhinoplasty "less" does not equal to "less risk of poor results", to the contrary, as a rule of thumb less invassiveness/technical complexity equals to calamity, as I said rhinoplasty is a very specific techinical universe, unlike others. If you are afraid to go for a revision, then I suggest you abandon the idea of improving your nose, however if you go ahead... do travel or do online consultations with revision specialists all over the country or the world. Do refuse any proposal based on revolutionary, magical or minimally invassive technical layouts.