Hi. Great question! So during a rhinoplasty, whether through an "open" or a "closed" approach the skin is lifted off the bone and cartilages to make changes to bone and cartilage. Then the skin is taped back down and a cast or splint is placed to put some pressure on the skin and prevent swelling from ballooning out the nose. The more is initially swells the more scar tissue fills the area and the long term "swelling" is this very same scar tissue. Scar tissue takes many years to melt down and you can see the nose shrink wrapping well beyond the first 12 months after a nosejob so that at 3-5 years after a nose job the nose is smaller and thinner than it was just a year out. That is one reason there is no real "final result" because it continues to change. Now IF there was a way to keep that skin stuck down tight on the newly shaped bone and cartilage then there would practically be very little swelling and very little scar tissue. But there isn't a good way. Taping can help but its not practical in most instances. Most patients cant keep tape on their nose for 3-6 months where the most initial swelling is forming. At this point with you being 4 months out taping wont do much but steroid injections can help reduce scar tissue. Nothing will really help with lifting the tip back up at this point other than fillers under the base to push it up or surgery to lift it up. Talk to your own plastic surgeon and see what he says. I haven't seen you so I can't tell you specifics. I can tell you that DO NOT obsess with the nose though. If its a better nose then enjoy it. You cannot pick out an exact nose and the surgeon has to work with what is there and then the nose heals and thats out of everyone's hands. Sometimes you get a near perfect nose and sometimes its just better in some ways which may come at a cost of other areas getting worse. It is a complex issue and many patients simply have unrealistic expectations as far as what can be achieved. Just because someone's friend or family got a certain type of nose it does not translate into you getting that as well. The tip always drops down a bit after rhinoplasty. But hopefully your nose is nicer now than it was before. Talk to your surgeon.
