Concerns about a still bulbous tip after 2 years since rhinoplasty, any suggestions?

Question

2y ago, I had a rhinoplasty to correct a dorsal bump. My surgeon suggested to reduce the tip's size to make the result more coherent while keeping the definition I liked, but it turn out to be very round, even after 1y+. When I touch it now, I can feel the shape of the cartilage underneath (which I like), but it is unapparent. Will the tip of my nose look as define as it did before and are there options available for me? I also apologize about the photos, they're quite silly :) Thank you!

Steven M. Denenberg, MD · Answer

So I can give you a couple of basic ideas about revision.How *much* to change the nose? We figure out what to do 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 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 always 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 only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
Remember also 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. Any revision rhinoplasty requires advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, 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 for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.  Although an exam in person is ideal, from your photographs alone it appears that you can benefit from a revision rhinoplasty for your nasal tip where the nasal tip cartilage is modified for a more refined, feminine, and less bulbous look.  The modification of your nasal cartilage can be done with trimming, stitching or grafting.  As you mentioned, you do have some nostril asymmetry, and if this is associated with a deviated septum, a septoplasty may benefit you as well.  The next step for you is to find the right aesthetic plastic surgeon.  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

Ronald J. Edelson, MD · Answer

The photos don’t really show the swelling very well. One easy thing to have done however, is to return to the surgeon and get steroids injected in the tip. That will definitely reduce swelling. It may need to be done a few times. Otherwise you actually have a nice result.  your surgeon did a very good job.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a tip refining revision rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. This can be designed to improve the symmetry of your nostrils. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon. If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Regan Thomas, MD · Answer

The photos you supplied are fun but really don't demonstrate your present nasal anatomy very well.  My best advice for you is to return to your rhinoplasty surgeon and have your present nasal status reevaluated. It may be helpful to consider steroid injection to reduce swelling. Best wishes to you as you pursue your treatment.

Kenneth R. Francis, MD, FACS · Answer

Dear MangoMaude,Your photos are not very revealing of your current concerns.  In fact, to me, the pre-operative photo looks like a post-operative one.  An evaluation in person would be necessary to adequately and specifically define your concerns and anatomic needs.  If you are dissatisfied, you should have a discussion with your surgeon.  Good luck!

William Portuese, MD · Answer

Much more information is needed, such as a copy of the operative report to determine what maneuvers were performed in your nasal tip.  It is also important to know how much cartilage is left over on the inside of her nose for potential grafting purposes.  A full set of facial photographs and an in-person examination going to be required, since  revision rhinoplasty is more more difficult than a primary rhinoplasty.  This is due to the fact of previous ulcerations to the normal anatomy and scar tissue formation.  At the time of the examination, it is to important to determine what is causing the bulbous nasal tip, is thick skin or excess cartilage? Each 1 of those issues are treated differently

Concerns about a still bulbous tip after 2 years since rhinoplasty, any suggestions?

Answers (7)

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