Is my nose tip too high after rhinoplasty? 3.5 months post-op (Photo)

At 3.5 months after rhinoplasty most of the changes have occurred and although your tip may drop very slightly it will not drop a great deal. Although your tip is a bit higher than many would consider ideal, it is within the range where it is not obvious.  In any event you need to wait a full year before considering additional surgery.  Fillers to lengthen the nose are not going to make a significant difference without distorting the tip.

This typical after rhinoplasty for the tip to appear shutter than before surgery. However the tip gradually drops down on its own over time. In fact I see I see more revisions for noses that are too long as opposed to too short

HiAs you stated it has been only 3.5 months since surgery. it is too early to be worried about your final results. Your tip is likely to drop. If you had a cumellar  strut placed, it is less likely to drop significantly but still there is so e room downward to let nose tip drop down. It takes at least a year to see final results.  I think at this point you need to wait for your nose to take shape.

after surgery the tip can counter-rotate for up to 6-9 months following surgery. However, the likelihood depends on what was done. If a tongue in groove or septal extension graft was used, then it is unlikely any change will occur. I would wait a few more months. Currently your rotation is borderline, not egregious and you only need a few degrees to be happy I think. 

As you know, it is too early to be worried about your final results. Although your tip is likely to "drop" after rhinoplasty, if you had a strut placed, it is less likely to drop significantly. I think at this point you need to wait for your nose to take shape, for the early swelling to settle and the tissues to soften. You are likely to get a little de-rotation. You can truly assess the results at 1 year and then decide on how to proceed. 

A columellar strut graft can come down a bit more as it is not secured to your septal cartilage. You do have thicker nasal skin which holds onto swelling longer than someone with thinner skin. You're still fairly early in the post op period and I would recommend giving your nose the time to heal. Remember, it takes up to a year sometimes even a year a half to completely heal from a rhinoplasty. 

Over rotation of the tip is not uncommon following primary rhinoplasty and could require a revision rhinoplasty to correct, but it is still too early to tell.  The tip may drop with gravity over time as your healing progresses depending on what steps were performed on the tip.  At only 3.5 months postop following primary rhinoplasty, you are still relatively early in your recovery with a great deal of swelling still remaining in your nose.  The swelling will resolve in a progressive fashion over months in the direction of gravity: the upper third will resolve in about 3 months, the middle third in about 6 months, and the tip in 9 - 12 months.  In general, it takes a full year to see the final result.  Therefore, it is still too early to judge the appearance at this point.  As the swelling in the upper lip decreases, the tip tends to settle downward.  I would recommend following up with your rhinoplasty surgeon to discuss any concerns you may have throughout the healing process.  Good communication and rapport between patient and surgeon both before and after surgery is very important.  If you are still dissatisfied with the appearance of your nose at 1 year and the responses you are getting from your primary surgeon, consider seeking consultation with a plastic surgeon well versed in revision rhinoplasty.  Best of luck in your recovery!


Ziyad Hammoudeh, MD

Thank you for your question and photos. At this point, it is still too early to tell if the tip is rotated too upwards. You are still very early in your recovery from a rhinoplasty. Full recovery from a rhinoplasty takes up to 1 year and the swelling should go down with time. Stay in close contact with your surgeon so that he or she can monitor your progress. As for your question regarding dermal fillers after rhinoplasty,  I would recommend waiting a year after rhinoplasty so the swelling has a chance to subside.

  Full healing takes 1 year, so it is really difficult to tell if the nose is over rotated or not at this point.  Best to follow up with your operative surgeon for steroid shots and taping to reduce the swelling in the tip of the nose.  Revision rhinoplasty can be entertained at 1 year if  the nose is over rotated.

Thank you for your question!
It is always difficult to be patient following a rhinoplasty!  You are still early in the healing process and the final result for surgery isn't seen for 12-18 months (and longer)  following surgery.  
Discuss your concerns with your surgeon as he/she should be able to address those concerns based on the specifics of your procedure and the progress that you are making.