19 years post rhinoplasty - would a revision help with dropping columella / bulbous tip? Can this also improve my smile? (photo)

Question

I had rhinoplasty in 2003. No complications but former surgeon is no longer living. My columnella appears to be dropping and getting more bulbous with age. Questions - 1. Would revision rhinoplasty make my appearance less “witchy”? 2. Could rhinoplasty also improve my smile by increasing tooth show in the center of my smile? I am trying to figure out the appropriate procedure(s) to accomplish a more feminine beautiful smile.

Steven M. Denenberg, MD · Answer

You only posted that mostly-frontal view, but it does show the prominence of the tip, and especially, that the tip seems to sit low. I'll bet, if you're looking for a more feminine nose, that you'd like to have that tip elevated significantly. About the smile -- not sure. When we revise a nose, we change the positions of the cartilages etc to put the nose in a nice position, but there's not something that can be done specifically to change where the lip sits on the teeth.
How *much* to elevate the tip, or deproject the nose, or make other changes? We figure that out 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 better just 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 really 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 the surgeon has that information and judgment best.)

I'd love for you to see some excellent morphs of what could possibly be done with your nose. It might make you feel better about the possibilities. Morphs help you plan your ideal goal, and help the surgeon understand what you need in order to be happy.
Remember 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. The changes that your nose needs require 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.

Nima Shemirani, MD · Answer

Hi @RSProfile87725. Thank you for sending your photos. I recommend seeing a revision rhinoplasty specialist for in person examination. There are several options for you that can be determined after examination. A rhinoplasty in my opinion is one of the most difficult procedures to perform. In my practice, I utilize piezosurgery. Piezosurgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezosurgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures. Best of Luck, Dr. Nima!

Jonathan Kulbersh, MD · Answer

Thank you for your question and photo. Revision rhinoplasty can address the dropping columella and bulbous tip you’re referring to. This procedure is unlikely to improve your smile in the way you’d like, but you may be a candidate for a lip lift. This surgical approach can increase tooth show when smiling by reducing the length of the philtrum, the indented area between your nose and mouth. 
When considering revision rhinoplasty, please keep in mind that each subsequent nose surgery becomes more complex due to the loss of structural support and scar tissue. The importance of experience, expertise, and artistry cannot be overstated. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon with expertise in rhinoplasty techniques who can review your surgical history and aesthetic goals. They will be able to suggest the best combination of treatments that may be right for you.

Mehmet Durmusoglu, MD · Answer

First of all, thanks for your question. Unfortunately, such bad results can occur with some rhinoplasty techniques. However, it would be best if you had a comprehensive revision rhinoplasty surgery to fix these major issues. These surgeries require an excellent experience and a sensitive approach. When what is necessary is done with the proper technique, the issues that arise in your first surgery will be fixed. Take care!

William Portuese, MD · Answer

A full set of facial photographs from all angles are going to be required to make a determination about how best to proceed, since revision rhinoplasty is more difficult than a primary rhinoplasty. If you have a hanging columella, that can be Addressed with skin and cartilage removal in that area through a closed revision rhinoplasty approach. If you have a droopy tip, then releasing the depressor septi ligament would be helpful to prevent your nose from dripping dynamically when you smile. Don't expect your smile itself to change. Thick skin in the tip of the nose prevents refinement in the bulbous nasal tip, so it's important to have realistic expectations

19 years post rhinoplasty - would a revision help with dropping columella / bulbous tip? Can this also improve my smile? (photo)

Answers (5)

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