Are these realistic expectations for my revision rhinoplasty? (photos)

I had my first rhinoplasty July 2013 and have a very uneven nose. My surgeon warned me it may turn and I may need a revision. I had a large dorsal hump removed and was supposed to have tip revision but my tip appears larger than before. I don't have very clear profile(side-view) pictures of before my first surgeery but this is my nose today no make up and my edited ideal nose. I just want to know one is this a normal situation and two are my expectations realistic? Or will I need a third rhinoplasty?

Doctor Answers 6

Are these realistic expectations for my revision rhinoplasty?

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In general, it can take up to 18-24 months to see the final result of a rhinoplasty. Nasal swelling after surgery influences the appearance of the nose. Swelling may be influenced by the following:

1) Thickness of the patient's skin
2) Whether the procedure was a revision
3) Whether the procedure was open or closed
4) Whether tip work was performed

The tip is the last to come around in regard to swelling. 70% of the swelling is typically resolved after the first 3 months and the remainder goes down over time. It is best to wait at least one year before performing any revision work, as you want to give the nose adequate time to heal. Swelling can interfere with the surgeon's ability to do his or her best work. Further tip refinement is possible with surgery if you have not achieved your ideal result by the time you have healed. I hope this information helps, and I wish you the best of luck. 

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Revision rhinoplasty candidate

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 A revision rhinoplasty is always more difficult than a primary rhinoplasty. The imaged results that are shown do seem reasonable, in  an experienced rhinoplasty surgeon's hands. The bulbous tip can be narrowed with suture techniques and possible cartilage removal as well. It is important to bring your old operative report to your new surgeon to get an idea of what was performed at the original procedure. 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Expectations after revision rhinoplasty

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It is unlikely that you will see any significant improvement over time, so it is appropriate to consider a revision at this point.  I agree that the tip is out of proportion to the rest of your nose.  This can be corrected, but revision rhinoplasty is much more difficult and carries much more risk than a primary rhinoplasty, especially when tip work is involved.

  Why was the tip left like this after the primary rhinoplasty?  

Before considering more surgery be sure to consult a surgeon certified by the American Board of Plastic Surgery who has a broad experience with this type of revision.  Review a portoflio of pre- and post-op revisions so you can gauge his/her level of expertise.

Revision rhinoplasty

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Swelling of the tip can take a year or more to soften. If you need a revision achieving your photo simulation may be possible but there is no guarantee.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Expectations from revision rhinoplasty

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I think the image adjusted photo you show would be a realistic expectation from a good revision procedure. Because the nose has been operated on previously, revision rhinoplasty is more challenging any you should seek an experienced surgeon who does them frequently.  The goal should always be to minimize the number of surgical interventions.

Mark Beaty, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Revision rhinoplasty

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I think your photoshop image is probably fairly realistic, assuming you have a talented surgeon performing your revision. The problem, I suspect, with your first surgery was failure to recognize the malposition of the cartilages that go from the tip out above the nostril.  They are pointing toward the inner corner of the eye rather than the outer corner.  Manipulation/modification of these cartilages incorrectly has caused them to curl even more upwards and caused shadowing around the tip and elevation of the nostril rims.  The cartilage will need to be repositioned or grafts will need to be placed above the rim to improve the nostril arch and get rid of the shadowing.  No offense to your surgeon, but it never hurts to get a second opinion (other than on Realself).  Good luck.

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.