Nasal Bone or Swelling After Rhinoplasty Revision? (photo)

If you have a residual bump on the nose after a second rhinoplasty and its been over a year then its probably not going to change :(.  There may be another reason why the bone isn't moving if it has been moved twice and filed down twice.  Visiting with a revision rhinoplasty surgeon for a second opinion may be a good option. 

While the nose tip swelling may last a year and sometimes longer, this swelling along the nose bones usually goes away faster. After the hump is removed a nose that looked narrow, normal or only minimally wide on the bridge becomes significantly wider which requires osteotomy (mobilizing and moving the nose bones) and moving the nose bones in to make the width of the bridge of the nose more pleasing. Sometimes the bones would not move in so easily and requires removal of a block of bone between the septum and the nose bones to allow them to be repositioned inwards. Otherwise this excess piece of bone will either resist narrowing the nose or the nose may look narrower during the surgery and widen while it is healing. It appears to me that you will need another surgery to remove a segment to allow for narrowing the bones that are still sitting away from the center of the nose. I suggest that you discuss this with your surgeon.

Thank you for the questions and the photo. It seems that the nasal bone on the right side stayed wide or flared after the surgery.  In some cases, swelling makes this look more prominent than it will end up. Often, though, this requires repeating the osteotomy. Generally, it is good to wait 9-12 months to allow for appropriate healing before doing this.

Be patient. It will take at least 6 months for this to resolve. If it doesn't you should seek a second opinion with an experienced revision rhinoplasty specialist.

You likely still have swelling throughout the nose that can be contributing to minor asymmetries. I would recommend following up with your surgeon so they can examine this area and determine the likely cause. 

Based on the dates you provided and the amount of swelling in your photo, it appears that you are still very early in your recovery from secondary rhinoplasty.  The bridge appears very wide, which is normal with the great deal of swelling you would expect for that timeframe.  I agree that your right nasal sidewall does appear more prominent than your left.  This could be swelling or incomplete correction of a bony prominence, but it is not possible to determine that without an in-person physical examination.  Being able to palpate the tissues would help answer that question.  Normally, prominent nasal bones are rasped down to a satisfactory height and then narrowed with precise bone cuts called osteotomies during primary or revision rhinoplasty.  I would recommend discussing your concerns with your rhinoplasty surgeon.  Only he/she will know exactly what maneuvers were performed during your operations.  I would recommend waiting a full year to see the final result before pursuing another revision.  If you decide to seek a second opinion after the swelling has completely resolved, I would recommend an in-person consultation with a surgeon well-versed in revision rhinoplasty so that he/she can thoroughly examine the inside and outside of your nose from different angles, feel the tissues, better understand your goals, and make more specific recommendations to achieve the natural look your desire.  Best of luck in your recovery!
Ziyad Hammoudeh, MD

Thank you for your question
I can see what you mean on the left side of your nose (nice picture by the way)
Physical exam will allow me to determine whether this "bump" is bone that needs to be reduced, the bone rebroken on one side or both to realign the nose or let time take its toll to let swelling diminish.
take care 
Dr Sarraga

It's very common to have swelling along the sites where the nose is fractured (osteotomies) in nasal surgery. Usually this subsides in a few weeks, but in some cases it may take longer - 6 months or more. Be sure to discuss this with your surgeon and perhaps consider a 2nd opinion if it is not resolving - in some cases the bone can be moved 'in' but may require more surgery. All the best.

There is swelling that happens after osteotomies especially if a small clot accumulates at the site. This will usually go away. Abnormal bone formation can also occur. You need to be examined

Without examining you, it is impossible to tell for sure.  However, if firm,  it is likely that there is a residual bone or bony overgrowth (callous formation).  
In some cases, this does go down, but not usually.  After waiting one year or so, it may be possible to take care of this.
Hope this helps,
Dr. Sam Most