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

... 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.

Swelling after any rhinoplasty persists for one year or more. Especially after revision rhinoplasty, swelling may take longer. There are other factors that affect swelling such as thickness of skin, use of cartilage grafting, the condition of the nose at the beginning of the procedure, patient propensity for scarring, number of revisions, length of surgery, among other factors. However, if you see significant deformity in the nose, then it's time for a consultation with a facial plastic surgeon.

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.