6 months post Revision Rhino and nose is bulbous and asymmetrical. Will the tip ever be refined? What are my options? (photo)

Six months ago, I had revision rhinoplasty for tip refinement and a hanging columella. I wanted a smaller, more refined nose. After surgery, my nose seemed large, asymmetrical, and swollen-- I took this as the norm. However, as the swelling has been going down, the tip looks more and more bulbous and asymmetrical. 1. Is this bulbous tip just a matter of swelling? Will there be a chance that it will look refined after some more time? 2. What are my options?

Doctor Answers 6

Well, it's nice to say that swelling isn't all gone at six months ...

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... but from these photos, I doubt that the nose will get where you want it to be on its own. Caution: I'm going to present what I think is the realistic evaluation, not the "oh, it's just swelling and it'll go away" evaluation that we often give our patients to keep them patient for the rest of the year.

It's completely true that the swelling will continue to diminish, and that swelling tends to stay longer after a revision than it does after a primary rhinoplasty. But there are a couple of problems. One is that your nose is long, with the tip drooping down, and the tip of the nose typically doesn't elevate as the swelling diminishes. We count on the tip to get more narrow with swelling reduction, but it doesn't tend to elevate.

Another problem is that I think I'm seeing some of the outline of your tip cartilages in the photos. If the size of your tip is mostly swelling, then that swelling would obscure the outline of those cartilages. Hmm.

And finally, if it were the case that you're eventually going to be happy with your nose when the swelling goes down all the way, then most likely it would look more narrow right now. Most of the swelling goes away in the first part of the year or year-and-a-half, and I'd be more optimistic if your nose were closer to your goal than it is right now.

See the "Web reference" link, just below my response. I made a computer morph of your nose, and an animation of the morph, to show the changes that are could be possible for your nose in truly expert hands; perhaps they show what your original goal for the nose was. I elevated the tip rather significantly, and of course narrowed the tip. I think it's important to keep the tip elevation in the equation; without it, the nose might look big even if the tip narrowed noticeably.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon, and, if you eventually decide to have another operation, how to determine whether your previous surgeon should perform your next operation.

Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.

Omaha Facial Plastic Surgeon
4.8 out of 5 stars 42 reviews

Bulbous Tip After Rhinoplasty

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Thank you for your question and photographs.  Swelling is usually more severe after revision rhinoplasty, so give this more time to settle down.  A bulbous tip can be due to swelling or the underlying framework is too large. Time will tell you the answer.  Good luck and I hope this improves without any further surgery.  

Raj P. TerKonda, MD, FACS
Phoenix Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Bulbous tip 6 months after rhinoplasty

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Results from rhinoplasty can continue to evolve for a full year, so don't panic yet.  If after a year the tip still lacks definition you will need a revision. For best information be sure to see a surgeon certified by the American Board of Plastic Surgery who has a broad experience with revision rhinoplasty.  Make sure to review a comprehensive portfolio of his/her work so you can gauge the types of results that are reasonable to expect.

Swelling of the nose

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6 months is actually a short time for resolution of nasal swelling.   Time is on you side and I have personally seen noses markedly decrease in size as swelling recedes  even up to 18 months.   So be patient and time will reduce the swelling of you tip.    You also appear to have quite thick skin on your nasal tip and this means a somewhat bigger tip than a person with thin skin. Wait till you are 18 months before having and other procedure.   Injection of steroid (Kenalog) into your tip in small doses should also help and reduce tip swelling.   My Best,    Dr Commons

Bulbous tip after revision rhinoplasty 6 months ago

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Nose refinements can continue years after surgery.  If your doctor is confident they refined your tip and you feel confident, I would continue to follow up with him/her.  I would continue to address your concerns.  Your doctor may recommend massage or steroid injections into the nose.

Revisions of revisions can be more difficult and generally performed after one year if necessary.

Ernest Robinson, MD
Aliso Viejo Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Give it some more time

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Thanks for the question and the photos. Rhinoplasty surgery can be very frustrating to you the patient, but often times it takes months, if not years for the nose to reach it's final shape. All of the swelling in the nose usually takes approximately 1 year to go down. The skin will continue to shrink over the nose for up to 5 years! Be patient for a few more months as there might still be some swelling which needs to go down. I would recommend following up with your surgeon to let them know how you are feeling. Best of luck!

~Dr. Sieber

David A. Sieber, MD
San Francisco General Surgeon
5.0 out of 5 stars 40 reviews

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.