Crooked bridge nose bump deformed cartilage after rhinoplasty (Photo)

Revision rhinoplasty is difficult. It is impossible to say how your results have turned out without a standardized photograph, showing before, and after results for secondary and tertiary cases, waiting a full year between procedures is optimal. My advice would be to discuss with your surgeon when she comes back from maternity leave.

I usually say to wait 12-24 months before making a final decision on a rhinoplasty. This may be even longer after a revision case (sometimes up to 5 years) because the lymphatics have been disrupted/injured twice. This also depends on what was actually done in both surgeries. I would just follow up with your surgeon and voice your concerns as this is early in the recovery and he/she will provide appropriate counseling. If it is not possible to follow up with one of your original surgeons...I would recommend seeing a board-certified plastic surgeon (with a 6 year integrated plastic surgery residency and The Aesthetic Society accredited aesthetic fellowship) for a consultation. I would recommend a physical exam in person to further evaluate what is going on with the nose.

In general, we like to wait about a year before performing a revision, but that can be shaved by a month or two, and anyway, this long after your surgery, you're mostly done with your swelling, and this is a reasonable time to evaluate the possibility of a revision, and what the goals of the revision would be.

You posted only a frontal view, and the pretty smile tends to distort the nose, so I wouldn't be able to make any recommendations other than the obvious bumps you point out. For example, id the tip still too low, does the bridge need to be adjusted other than that bump on the left side. The bump on the left tip is a little concerning, because it's usually a complicated task to get the tip symmetric and smooth.


How *much* to change the bumps, or adjust the bridge, or possibly 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 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. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

To make an assessment on the outcome of a plastic surgery procedure we generally need to see a complete set of proper before and after pictures. If you’ve had more than one procedure than you should include before, and after pictures of each of the previous procedures. If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.
Your situation is far too complex to give you an assessment based on the information provided. Follow up with your provider when she’s back to work.Rhinoplasty surgery is inherently complex and patience should be highly selective when choosing providers. Revision surgery is many times more complex and difficult than primary procedures so the need for provider selection goes without saying.
Finding the right provider for rhinoplasty surgery or revision rhinoplasty surgery is not always easy or straightforward. I generally recommend patience look for senior plastic surgeons who preferably exclusively focus on rhinoplasty surgery, or have a strong emphasis on rhinoplasty surgery in their background.
I generally recommend patients have multiple in person consultations before selecting a provider.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar situations to your own.
an experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients.
Being shown a handful of pre-selected images, representing the best results of the providers career is insufficient to get a clear understanding of what average results look like in the hands of that provider or how many of these procedures they’ve actually performed.
With each operation rhinoplasty surgery becomes more complex and more difficult to get quality outcomes.
In the end, patient candidacy, and provider skill are the two single most important variables that determine quality outcomes.
For most patients, there isn’t much you can do about your own candidacy so provider selection becomes the only variable you have control over.
I recognize you’ve already had the procedure, but for those who are contemplating having surgery, I cannot emphasize enough the importance of provider, selection, and properly vetting plastic surgeons through multiple in person consultations.Best,
Matts Hagstrom, MD.