Is my nose tip too upturned? What can I spect from another procedure? Is there risk to things go worst?

Question

My rhinoseptoplasty was 16 months ago, I've been waiting all this time hoping my nose tip descend. I think now I've got the definitive look. How much nasolabial angle do I have? It is on a normal range? I think my nose looks fake, I was very clear asking my surgeon a straight nose, but I think it doesn´t look natural, it isn't straight. Also it looks slim. What are my options to achieve a straight one? Fillers are an option? Its simple or a dificult situation?

Steven M. Denenberg, MD · Answer

Your nose's tip is too "projecting," which means it sticks out too far away from your face. The tip needs to be brought back closer to your face. We call that "de-projecting" the tip.
The woman in the short video that I posted with this answer had the tip of her nose de-projected a significant amount in her operation.
Then, when a nose is de-projected, it tends to *look* longer, as if the tip had drooped. So really, the tip of your nose doesn't have to be lowered very much, maybe it doesn't need to be lowered at all!More: your bridge is strong up at the top of the nose -- in front of your eyes, or just below your eyebrows. Especially if we bring the tip of the nose back closer to your face, it's important to reduce the strength of the bridge up there at the top, or your profile would resemble the profile of a Roman statue, where the profile of the forehead slides right down onto the nose, without that little dip we like to see in front of the eyes. Search for Roman statue profile to see what I mean. You already have a little of that appearance.
How *much* to de-project the tip, or to lower the bridge in front of your eyes? 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. Especially your nose, because you would see that the main problem is not how short the nose is, but the tip's projection, and the excess strength at the top of the bridge. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. (Side note: in my opinion, morphs should always 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 only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)But the bottom line is that this is a difficult revision operation, but one that should have good success, in truly expert hands. Fillers can't do anything at all for your nose.
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 for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Jonathan Kulbersh, MD · Answer

At this point, you are likely seeing the full outcome of your first surgery. I agree a revision rhinoplasty would be your best bet. While fillers could probably create some improvement, the results would just be temporary. A revision procedure can correct the slope of the bridge and well as the overly-rotated nasal tip. Keep in mind that revision work is even more complex than the original procedure. It is likely in your case you will need some cartilage grafting to get the results you want. Make sure the surgeon you choose is not only board-certified, but also extremely experienced in revision nose shaping techniques to ensure you enjoy a better result this time around.

Thomas A. Mustoe, MD, FACS · Answer

I would agree that you nose looks like you have had surgery with an upturned and overly sloped appearance.  Filler is temporary and a proper revision should help a great deal. Cartilage grafts will be required to build up the dorsum and reduce the slope.   the tip is somewhat over projecting and reducing projection will improve the upturned appearance.   Revision surgery is more complex than primary rhinoplasty but with an experienced and skilled surgeon you should be  able to achieve your goals.

Toby Mayer, MD · Answer

Revision rhinoplasty for the unsatisfactory result. Fillers last 2 years and a revision will ;not need further surgery. If you want re-rotation of your tip this will require a cartilage graft from ;your septum to lengthen the nose. See a VERY experienced revision rhinoplasty surgeon for this!

Michael Elam, MD (retired) · Answer

Dear Uomoci, Unfortunately you will require revision surgery to correct the over rotated tip and over resected dorsum. I agree with your assessment and I would start interviewing some expert revision rhinoplasty surgeons to discuss the possibilities that can be achieved. In the interim I would suggest that you request a copy of your preoperative photographs as well as your operative report so that you may have these on hand for your consulting surgeons. It is always helpful to understand what techniques were used in the primary case. Best of luck to you...Michael V. Elam, M.D.

Is my nose tip too upturned? What can I spect from another procedure? Is there risk to things go worst?

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