Pollybeak? Revision required? 8 weeks post op. (photos)

Question

I had my primary nosejob 8 weeks ago. My Dorsum was shaved, deviated septum straightened, tip was NOT refined. All in a closed surgery. When I got my cast taken off everything seemed fine. Nose was straight, no bump, every angle was great. After a few days my nose started deviating again and my supratip started getting very swollen. The enclosed photos are from 7-8 weeks post op. it has remained moreor less the same since week 1. Could it be polly beak deformity. Is revision required, what kind?

Andrew Miller, MD · Answer

It is still very early in the process and supratip swelling can still go down significantly. As for the crookedness, it can be very difficult to fix completely, but sometimes additional things need to be done to keep the nose straight. Be sure to discuss your concerns with your surgeon, but additional opinions can always be sought out. Typically you should wait closer to the six month mark, before even thinking about revisions.

Eric M. Joseph, MD · Answer

Your nasal profile appears pleasing, and the fullness above your tip may be swelling. Supratip swelling may be addressed with dilute triamcinolone acetonide injections (steroid). Your bridge appears a bit wide on front view, but that could be swelling as well. Consider brinfing up your concerns with your rhinoplasty surgeon. Wishing you well. Dr Joseph

Jonathan Kulbersh, MD · Answer

This is very common due to swelling and the impact of flying/cabin pressure. It can be frustrating to go through rhinoplastic surgery and still have a “big” nose, but it is not a permanent condition. You need to have patience with your body as it begins to heal. The skin, bone and cartilage are all traumatized during surgery. Inflammation (swelling) is the normal response and will help your nose to heal and look beautiful in the end. If, one year from now, you are unhappy with your nose, then that is the time to think about a revision procedure. Right now, concentrate on other things you like to do and let your nose take its time to heal. I hope this helps.

Andre Aboolian, MD · Answer

Its too early to tell.  You have a lot of surgical swelling and you should give it at least another 6 months from the date of your surgery to get a better idea of your final result.  Speak to your surgeon and follow his/her recommendations.  Andre Aboolian, Plastic Surgeon, Beverly Hills California, andreaboolian.com

David A. Sieber, MD, FACS · Answer

Thanks for the question. You still have a significant amount of swelling which will linger for 6-12 months after surgery. Sometimes the swelling can by asymmetrical and cause the appearance of further dorsal deviation. This should all improve with more time. I recommend following up with your surgeon as they might be able to use a steroid injection or taping to help reduce some of the swelling. Best,~Dr. Sieber

Edward Farrior, MD · Answer

Not to be difficult but these are questions you should be asking your primary surgeon.  If you have such little confidence in them then you should have chosen a different surgeon in the first place.  You have mild postoperative supratip swelling with good tip projection.  The skin on the tip of the nose is quite sebaceous and thick and will tend to swell and remain swollen for 3-6 months after surgery.  The deviation of the nasal dorsum is another issue.  I would ask your surgeon about nasal exercises to help reduce the risk of deviation and possibly reposition the cartilaginous framework of the nasal dorsum.  If revision rhinoplasty is necessary complete release of the nasal septum from the upper lateral cartilages will be required to truly straighten the nasal dorsum.  An easier procedure is to camouflage the deflection with grafts or even injectable fillers.  In acute postoperative asymmetry injectable fillers are a nice alternative to camouflage the deformity and allow an adequate amount of time for complete healing to occur.

Robert L. Kraft, MD, FACS · Answer

You are very swollen and need to allow time for that to resolve.  Pre op photos would be helpful. In men, the nasal bones are thicker and more likely to deviate to some extent. If you had a strong pre op deviation, then this would not be surprising.

Steven Wallach, MD · Answer

You are still very swollen. The nose will shrink somewhat with time. Your nose will likely stay crooked from the front view, but at this point you can not have a revision.

Anup Dhir, MD · Answer

Hello and thank you for your question. The swelling post rhinoplasty is expected and can take up to one year to settle. The final shape of the nose becomes apparent then. It is too early to comment, so be patient and allow the healing process to take place.All the best.

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