Can a Nose Still Refine 1 Year Post Revision Rhinoplasty?

Depending on the nature of your surgery, it may take longer than one year to see the final result, and improvement is still possible. I have seen some cases where it takes longer. With a revision that involves tip work, the amount of time it takes to see the final outcome is influenced by the following:

1) The extent of the tip work, and how many revisions you have had in the past
2) The thickness of your skin

For now, I would wait before considering another revision. 5-Flourouracil mixed with kenalog is a powerful way to help reduce swelling, and soften and potentially reduce the amount of scar tissue present after a  revision rhinoplasty.  I have also seen some patients that are diagnosed with scar tissue actually have think sebaceous skin.  In these cases, a light dose of Accutane, a medication that reduces the thickness of sebaceous skin, may help define your nose.   I would recommend speaking with your surgeon about this option.  If he is not receptive, I would recommend seeking a second opinion with a qualified surgeon. Thanks and I hope this helps!

One year is the general timeframe during which a recovering nose
continues to take shape as swelling subsides. After this period, it is not
likely that you will see drastic changes or experience any more noticeable refinement. Your surgeon
will be following your recovery closely, especially at the beginning stages of
your healing process. Because he or she knows your condition best, your surgeon
would be the best person to consult about whether it is possible that your nose
is still healing. Still, I must reiterate that you should be realistic about
what further changes you are expecting to see, as a nose is typically either
fully healed or very close to being fully healed after the initial year of
recovery. I recommend scheduling a follow-up visit with your surgeon to address
this concern in person and to discuss your options accordingly.

Even though most people can see final results from a rhinoplasty by one year post op, for patients with thick skin, it is very common for it to take as long as two years before final results can be seen. Continue to be patient during this time.

Most surgeons will tell you to wait for one year to see the full potential of a PRIMARY rhinoplasty.  There is less conventional advice when it's revision.  Inm 15 year experience, I would say you can still see some additional refinement after one year.  However it's going to be minor.  Keep in mind that you have had two surgeries already, so the thick skin comment is being driven in part by a layer of healed "scar" tissue.  So things may not redrape as tightly or with as much definition as you would like.  Contemplating a second revision rhino may only make that issue worse, so don't jump to that alternative without a full conversation with your surgeon.  

I have had a few cases where the skin just did not shrink wrap to the cartilage changes I surgically refined.  The skin just was too thick, or at times reduction rhinoplasty just leaves an amorphous layer of skin without enough cartilage projection back into it to create definition.  So continually cutting or sharpening or reducing cartilage may not be the answer.  Make sure you get a few opinions.

Without knowing exactly what was done during your surgery, it's difficult to give you a precise answer.  In my experience, I would expect most of the swelling to be gone a year after a rhinoplasty.  I would not think that you would see any significant improvement after a year.  

Thick skin sometimes obscures the cartilage framework that is refined with a rhinoplasty. So it is possible that there is a limit as to how much tip reduction you can achieve. I would suspect that most, if not all, of your swelling has subsided after one year.  If your nose still appears swollen, then it is most likely that you may desire a revision or at least an opinion from a board certified plastic surgeon regarding a potential revision. 

 

 

Hi Sarah,

Most of the swelling goes away by one year after rhinoplasty.  I cannot make a complete judgement without seeing pictures, but if your nose is still quite bulbous by this point, there is usually not a great chance that you are going to see much improvement.  That being said, there are occassions in which the skin envelope "shrink wraps" for many years after rhinoplasty, particularly in thin skinned individuals.  Rhinoplasty on patients with thick skin can be challenging in the sense that changes to the underlying cartilaginous framework are often more difficult to appreciate.  If you are considering another revision, it is resonable at this point to seek further consultation from a plastic surgeon in person. 

All the best!

Jeremy White, MD

In my experience, not all swelling is resolved after 1 yr after surgery, especially as it relates to revision rhinoplasty and thick skin. You should get further refinement, but probably not a dramatic change.

 

Dear Sarah,

Most plastic surgeons agree that the one year time frame is typical for healing with rhinoplasty and most likely with revision as well. Sometimes extenuating factors may increase this time frame i.e. thick skin, however the changes would be minor in my opinion. You may have scar tissue that you are feeling and a direct examination by your surgeon will be able to provide the proper answer to your question. Best regards, Michael V. Elam, M.D.

In some patients with thick skin I have seen some improvement 18-24 months after surgery. An examination and review of the surgical procedure would help in answering your question. Having said that it is not too soon to consider a revision.