Is the Nasal Tip Asymmetry Likely to Heal with Time?

Question

I am just over 20 wks postop (open septo-rhinoplasty). Had a hump removed, bridge thinned, and the tip slightly elevated and substantially thinned. Healing has been comfortable and I've been told by my surgeon to massage tip to reduce swelling.

	I have noticed asymmetry in the nasal tip (left side in picture (my right)seems sharper/ more defined than right), and asked surgeon who said the large portion of tip removed left scar tissue nd swelling that will subside in time. Does that seem feasible

Eric M. Joseph, MD · Answer

I read your concern and reviewed your photo. The slight indentation in the right side of your tip 4 months after Rhinoplasty Surgery may be filled with an Injectable Filler to improve symmetry. Your tip has some degree of post-surgical swelling that will take a year or more to completely resolve, and there is no harm in watchful waiting as your surgeon suggests. If you're uncomfortable waiting, a conservative, carefully performed Injectable Filler treatment may be considered. My personal preference is to use Silikon-1000, an off-label filler for permanent results.

	I hope this is helpful for you.

Ali Sajjadian, MD, FACS · Answer

Thank you for your question!

It is understandable that you are
concerned especially with the asymmetry. Changes after rhinoplasties vary with
every patient and what you are experiencing is not uncommon.

It is important to keep in mind that it
is early to pass a judgment. Usually, a year is required before formulating how
your nose will be, but longer with a thick skin. Even then, your nose will keep
shaping itself to complement your face for better results in the years to come.

My best recommendation at the moment is
to be patient and allow nature to take its course. There is no doubt that once the swelling resolves, more definition and
shape will be achieved and you should be happier with the results.

Also, it is important that you keep
communicating with your surgeon and work as a team together to achieve the best
results possible.

Congratulations on your surgery and remain positive!

Ali Sajjadian, MD FACS

Scott Trimas, MD · Answer

There is some definite asymmetry to your tip which may or may not resolve itself over time. It is best to wait at least one year before addressing the problem if it does not resolve. Sometimes very simple procedures can be done to correct asymmetries which may not bother you after the nose has completely healed. Action too soon can result in a negative outcome. Sometimes scar tissue can develop causing a temporary problem that can be addressed by your surgeon. I would recommend continued follow-up with your surgeon.

Louis W. Apostolakis, MD · Answer

Looking at your photographs I can clearly see the asymmetry to which you refer.  At 20 weeks your nose no-doubt still has swelling and the swelling is likely to be asymmetric to some extent.  However, the difference between your left and right is significant and it probably is not all swelling.  Having said that, only time will tell.  I absolutely do not recommend any revision surgery until you are at least a year from your original surgery.  Another surgeon suggested fillers as a temporary stop gap.  That is reasonable, though it may cause some swelling of its own and will cost you some money.  You will also need to be sure that it has all dissolved prior to evaluating for a revision, should it be necessary.

Peter E. Johnson, MD · Answer

The jury will be out on the 'final' result for six to twelve months after open rhinoplasty. Minor asymmetries should not cause any great concern, and massage can help soften the skin a bit. We would avoid temptation to do anything until you are much further along.
	Best of luck,
	peterejohnsonmd

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