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

Tal T. Roudner, MD, FACS · Answer

At 20 weeks you should start getting a good idea of how the tip of your nose is going to look like after rhinoplasty surgery. Although it is to early for the final results of the Rhinoplasty and when done with open technique the tip of the nose swelling last longer up to one year.

	Even if you do have some asymmetry no attempt to correct it should be done before a whole year has passed since the original surgery.

	Good luck!

John A. Grossman, MD (retired) · Answer

Patience is a virtue in surgery as in life! Whether your rhinoplasty was performed "open or closed", healing and resolution of swelling occurs first at the upper part of the nose and lastly at the tip. Full tip softening and un-swelling will really take about 1 year and doesn't necessarily occur symmetrically. At this early stage (barely 5 months), you can't accurately judge the final result and final symmetry. Meddling at this point, whether by injecting steroid/cortisone or a "filler" would be a mistake as you would be interfering with the natural healing process. If any corrections or minor revisions were necessary, they should be considered only when full healing and softening have occurred. Of the suggestions made by others, massage/compression of the tip in a fashion directed by your surgeon is the only one that would be reasonable.Good luck and think positively.John A. Grossman, M.D.

Jon Sattler, MD (retired) · Answer

It is hard to determine what is going on from your photos alone. It would depend alot on what procedures  your surgeon actually did originally.  The conservative measures suggested above might be helpful. However, it might be helpful to discuss the procedure with your surgeon and perhaps seek another surgeons opinion as to what might be going on.
	In any event, you need to be seen in  person  by a Board Certified Plastic Surgeon to assist you in making a decision as to what is best for you. I hope that this is helpful for you . Jon Sattler, MD Board Certified Plastic Surgeon, Glendora, California.

Francis R. Palmer, III, MD (retired) · Answer

Open Rhinoplasty disrupts the nasal skin lymphatics, IMHO, for up to 6 months which does create more residual swelling than a Closed Rhinoplasty or Tip Plasty. I'd wait for the 6-7 month mark before worrying. Nothing much to do beside, nasal massage and kenalog injections at this point.

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