Fibrosis on thin skin post Rhino? (Photo)

We only have frontal views here, and it really takes all angles to *see* what's going on with a nose, but I don't see anything other than a nose that is still prominent after a primary rhinoplasty. The tip is wide and sits low, and I'll bet you'd like to see it elevated and narrower. There is no skin abnormality evident, nor edema, and I've never seen a case of "post rhinoplasty fibrotic syndrome." The fact that you're not getting cooperation from your surgeon is a clue. Things like fibrotic syndrome are a surgeon's excuse for why the nose is still too big after surgery.

Another surgeon's evaluation might say that there is no swelling or skin problem, but just that the cartilages aren't in a position to make the tip narrower and the nose shorter, and a revision in expert hands will do the trick.

How *much* to elevate or narrow 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, although I bet you already have that figured out.

An examination would be necessary to determine why your nasal tip appearance is wide. In our experience, steroid injections are helpful after rhinoplasty when somebody has supra tip swelling that can mimic a polybeak deformity. When there is diffuse nasal tip fullness, I would be concerned that a steroid injection might result in a visible skin indentation. Please consider getting a copy of your operative report and Consulting with another reputable rhinoplasty specialist so you can see what might be helpful for you moving forward. Thank you. Sincerely, Dr Joseph

Steroids may help a little in your situation. However, they are best introduced earlier, during the scar maturation process, to have the best effect on the skin/scar.

Since you also have concerns regarding your alar region, I'd recommend consultation with an experience rhinoplasty surgeon for their advice for all of your concerns.

Massage can also help with scar remodeling and should not cause any long-term risk to your nose.

To make an assessment regarding the outcome of a plastic surgery procedure we generally need to see a complete set of property before and after pictures.
If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
At this point your results are final and there is no longer swelling.
You’re not forming new scar tissue and all the scar tissue is at this point mature and there’s no needfor a steroid injections.
Your outcome is a direct reflection of your candidacy for the procedure, and how the operation was performed.
Plastic surgeons are responsible for the outcome of the procedure and patients are responsible for selecting the provider who did the operation.
If you want a proper in person second opinion consultation I suggest you schedule those as in person consultations with plastic surgeons in your community who have extensive rhinoplasty experience.
Secondary rhinoplasty surgery is Fairly complex and in general, I recommend anybody seeking rhinoplasty surgery especially secondary to find plastic surgeons who exclusively on rhinoplastic surgery or at least who is highly focused on this procedure.
For second opinion, consultations come prepared to bring with you a complete set of proper before and after pictures and a copy of your operative report.
These are both available from your current providers office if you request them.
Best,
Mats Hagstrom, MD