Is having a tip plasty alone after initial rhinoplasty safe?

Question

I had rhinoplasty 10 months ago to straighten my crooked nose and straighten the bump on my nose. I didn't change the tip, but after surgery now I feel like my tip is huge. It even seem bigger than before. It is droopy, big and extremely round. I need a tip plasty, but I'm scared that it would be too risky. Would a simple tip plasty after initial rhinoplasty be safer than a full revision?

Thomas A. Mustoe, MD, FACS · Answer

Although pictures would be helpful after 1 year tip rhinoplasty should be safe and from your desert should be able to take care of your problem.  Sometimes tip rhinoplasties can be done as an office procedure under light oral sedation and local anesthesi.   However any revision is more difficult than primary rhinoplasty and outcomes are likely to be  better with experience in tevisions

Steven M. Denenberg, MD · Answer

What you are describing is unfortunately common -- that inadequate work on the tip of the nose during a rhinoplasty leaves the tip too wide and the nose too long. The good news is that, if the problem is that too *little* work was done -- as seems to be your case -- then there's plenty of cartilage remaining to work with in a revision operation.It might be the case that most or all of the work your nose requires is work on the tip, but any revision is complicated, and any work on the shape and size of the tip is complicated, even in a first-time rhinoplasty. But there really isn't a distinction between a "tip" rhinoplasty and a "full" rhinoplasty, because in a "full" rhino, still about 80% of the work is work on the tip!But narrowing and elevating the tip, in expert hands, are two of the more predictable changes to make in a revision.
The woman in the short video that I posted with this answer had the tip of her nose narrowed and elevated in her revision operation.How *much* to elevate the tip, or narrow the tip, or are there other areas of the nose that need addressing? 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. 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. Profile and three-quarter views would be particularly important in morphing your nose. (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.)
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 by the operating surgeon 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?

Stephen J. Pincus, MD · Answer

Revision rhinoplasty, if performed on the right candidate at the right time post-operatively by an experienced surgeon should not be very risky. Obviously, you would like to wait till all of the swelling from your first surgery has subsided. This depends on many factors including skin type, amount of surgery performed and trauma related to the surgical skills of the initial surgeon. This time period is usually 6-12 months after the last surgery. Doing a tip-pasty following a formal rhinoplasty is usually a much simpler procedure. You should contact surgeons who are experienced doing revision rhinoplasty and seek either a virtual or in-person consultation. The latter is always a better way to go, if it is convenient.

William Portuese, MD · Answer

Much more information is needed such as a full set of facial photographs, a copy of the operative report, and an in- person examination.  Revision rhinoplasty is 1 of the most difficult operations to perform  in all cosmetic surgery.

Is having a tip plasty alone after initial rhinoplasty safe?

Answers (4)

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