What can be done to make my round nose tip appear more refined and symmetrical?

Up close photos are difficult to interpret. We can see that you have relatively thin nasal skin and some asymmetries of your tip and nasal base. If this is causing you severe dissatisfaction, please meet with several reputable rhinoplasty specialists so you can see what might be best for you moving forward. Thank you for this question. Sincerely, Dr Joseph

Hello and thank you for your question.

Although an exam in person is ideal, from your photographs alone, I agree that your profile view looks great but you can benefit from a subtle tip refinement with straightening of your tip cartilage complex. Though the change may be subtle, the surgery to perform this is significant.

I would recommend multiple cartilage grafts including extended spreader grafts, extended alar contour grafts, and a columellar strut if not already performed. Due to your prior rhinoplasty, the cartilage in your septum was likely harvested and so you will likely require MTF (Musculoskeletal Transplant Foundation) aka cadaver cartilage to perform this revision rhinoplasty. Further modification of your nasal cartilage can be done with trimming, stitching or grafting. Also note that if your septum is deviated and you have breathing difficulty, a septoplasty may benefit you as well.

Since you are 3 years out, all the swelling has likely resolved and the next step for you is to pursue the right aesthetic plastic surgeon for your revision rhinoplasty. In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Hello and thank you for your question. Based on your photographs, you may benefit from a tip refining revision rhinoplasty and reconstruction of your dorsal aesthetic lines. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement. 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

It's very difficult to get the tip of the nose and nostrils to be very symmetrical, especially when there's a little twist to that flexible part of the nose. Your bridge line demonstrates a residual dorsal hump, wide nasal bones, and inverted upper lateral cartilage is also known as an inverted V deformity. Those issues can be addressed with a revision rhinoplasty procedure. Also important to know how much cartilage is left over on the inside of your nose for grafting purposes. A copy of the operative report would also be helpful in addition to an in-person examination. Revision rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery.