Bulge on side of nose, bumps on bridge & pointed tip following septorhinoplasty in 2017, options? (Photos)

Question

I had a septorhinoplasty in 2017 which did not completely fix my deviated septum, so I had a revision septoplasty in 2019. I now have a bulge on the right side of my nose, which is creating a crooked appearance of the tip. I can’t tell what the bulge is, but when pressing on the top of it I can hear a crackling sound like there is mucus trapped. There are also a lot of uneven bumps on the bridge, and for some reason my tip has become pointier over time. What are my options here?

Gianfranco Frojo, MD · Answer

I would recommend a revision rhinoplasty with cadaveric fresh frozen cartilage. In addition, I would recommend placing some temporalis or posterior auricular fascia over the dorsum of the nose to help further camouflage the irregularities. This is a very complex issue that needs to be addressed by a really experienced plastic surgeon in rhinoplasty. I would recommend performing a revision rhinoplasty with additional cartilage grafts. I recommend finding a board-eligible or board-certified plastic surgeon (not "facial plastic") with aesthetic fellowship training.

John Michael Thomassen, MD · Answer

I would recommend a cosmetic rhinoplasty to smooth out the dorsum and refine and straighten the tip.

Eric M. Joseph, MD · Answer

Nasal skin is the thinnest at the junction of the bone and cartilage of the nose in the upper 1/3 of the bridge, right where you are seeing your irregularities. Based on your photos, this is associated with a crooked nasal appearance and an overprojected and droopy nasal tip appearance. If you are happy with the appearance of the tip of your nose, microdroplet Silikon-1000 injections may be considered for camouflaging these irregularities and for achieving a straighter nasal appearance, depending on your examination. Depending on your examination, you may require revision rhinoplasty surgery. Please consider consulting with several reputable rhinoplasty specialists so you can see what might be best for you moving forward. I hope this helps. Sincerely, Dr Joseph

Steven M. Denenberg, MD · Answer

From these photos, the bulge appears to be your right tip cartilage. When the right tip cartilage is stronger/longer than the left one, it can push the tip to the left. These tip cartilages also are responsible for holding the tip down, and it appears that the tip of your nose might sit lower than you might feel is ideal. Elevating the tip might be a good thing to do. In any case, if you are to have a revision, you should look at the whole spectrum of what you still are not satisfied with, and at least try to address all of them. If a revision were done, the irregularities on the bridge could probably be smoothed as well.

How *much* to elevate the tip, or thin the right bulge, 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.)

Finally, 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 it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Bulge on side of nose, bumps on bridge & pointed tip following septorhinoplasty in 2017, options? (Photos)

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