Right side of nose is slightly bulbous with asymmetry. Is a revision warranted for for tip refinement and asymmetry? (Photos)

Question

I’m considering a revision rhinoplasty for more refinement in my tip. I am fairly satisfied with the left side view of my nose, but on the right-sided view there is some asymmetry and still a slightly bulbus tip, that lacks refinement. I find myself never wanting to take photos from this angle. There is also a slight bump on my bridge which I had never had previously. And from the underside view of my nose, you can see there is a slight asymmetry to the nostrils. Wondering if a revision would be warranted to correct these issues and give me that tip refinement I’ve been seeking.

Alejandro Nogueira, MD · Answer

I understand how difficult is to read this and accept the situation, but you are minimizing the calamitous technical result of your previous rhinoplasty. There are extensive damages affecting all nasal areas or key points:
-open roof
-inverted V
-middle vault collapse
-shattering of nasal bones
-irregular dorsum profile
-alar rim retraction
-nasal valve collapse
-none or minimal tip treatment
-etc

Do consider a very comprehensive revision with a resolute revision rhinoplasty surgeon.

Eric M. Joseph, MD · Answer

We can tell that you have thin skin, since we can see the cleft in between your tip cartilages, as a vertical line. Say narrowed tip appearance, and if you have a dorsal hump that needs to be removed, you may consider several reputable rhinoplasty specialist so you can explore your options moving forward. Wishing you well. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a revision rhinoplasty to help improve symmetry of your tip. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Tanveer Janjua, MD · Answer

I have a saying for repeated minor rhinoplasty revisions, 'Quit while you are ahead'
Small changes can lead to more changes to bigger changes or worst outcome. Hence it can become a slippery slope. 
You look great.
Regards
Dr. Janjua

Selcuk Yazan, MD · Answer

Thank you for your question. 
This is thoughtful, important and often comes up. Whether or not to pursue a revision is a personal decision. If your nose is functioning well and you’re generally satisfied, there’s no medical reason a revision must happen. If the asymmetry or contour of the tip is something you find distracting or that doesn’t feel like you, it’s absolutely reasonable to explore revision or refinement options. 
What’s important to understand is that rhinoplasty is one of the most commonly revised procedures in aesthetic surgery. In fact, most noses could benefit from a touch-up. That’s not a reflection of poor surgical technique, it’s a reflection of how complex and dynamic the nose truly is. If every surgeon shared this openly, many patients might hesitate or go searching for someone who promises a perfect “one-and-done” result. However, the reality is, healing is not always predictable. A surgeon can do everything right in the operating room, but the nose might not heal exactly as planned. Swelling patterns, scar tissue, and even how you sleep can cause subtle shifts over time.
It’s also important to know that a nose can only be downsized or reshaped so much in one surgery. The skin has to adapt to what’s underneath it, and especially in patients with thicker skin or a more complex starting point, there are limits to how far a result can be pushed safely in a single operation. Sometimes the desired outcome isn’t achievable in just one step, not because the surgeon didn’t go far enough, but because the body needs time to respond and adjust. That’s when a second, more refined stage can bring everything into place.
Small refinements are rarely as simple as they sound. The nose works like a tripod: if you change one area, the rest has to adjust to stay balanced. For example, making one side of the tip less bulbous can affect rotation, symmetry, and the overall alignment of the bridge. What may appear to be a small revision might actually require addressing the full structure to achieve harmony.
A nose is also comprised of 2 nostrils and a tip which requires being centered. The slightest deviation inside may cause asymmetry. This requires opening the entire nose and changing many parts just to correct a millimeter on the exterior. 
The nose is also a living, breathing organ that’s constantly in motion. It changes with emotion, breath, and expression. The muscles around it help you emote as well. Inside, the turbinates swell and shrink throughout the day, and you might notice one side appearing more full just from how you slept (suppressing one sides turbinates.) When you are happy and you smile, you take in more oxygen. A nose will never look exactly like it did in the operating room or in early post-op photos because it’s constantly responding to your body and your life.
So is a revision warranted? Only you can answer that. Your experience is common, your observation is valid, and that seeking refinement is a normal and respected part of the process.
Thank you

Right side of nose is slightly bulbous with asymmetry. Is a revision warranted for for tip refinement and asymmetry? (Photos)

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