Is tip revision alone possible? (Photo)

Hello and thank you for your question and the pictures. Unfortunately no, you actually have a VERY difficult problem to fix. Your tip asymmetry after a prior rhinoplasty is due to contractile scarring forces, which can unfortunately distort rhinoplasty results over time as the underlying tissues heal and shrink, altering the shape of the nose. There are certain maneuvers which can be performed during rhinoplasty surgery to prevent such retraction and distortion- I actually perform these preventative maneuvers in all my rhinoplasty surgeries for this very reason. Because of the extensive scar tissue present, you would need a "full" revision rhinoplasty (instead of just working on the tip) to properly correct your issue and to solidly reinforce the entire underlying framework to assure you get the BEST long term results. Anyone who tells you otherwise is doing you a HUGE disservice!

Revision rhinoplasty is truly a surgery of millimeters- they are the most technically challenging procedures in all of plastic surgery! Because your nose is the DEFINING feature of your face- I would only recommend seeing a surgeon who specializes in revision rhinoplasty procedures, and who has significant training and experience performing these surgeries. I actually trained under one of the world leading revision rhinoplasty experts (who performs 1,000+ nosejobs annually).

I recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with revision rhinoplasties) to thoroughly discuss your surgical goals, undergo a formal examination, evaluate your options, and develop a personalized plan just for you. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

You can certainly just do a revision rhinoplasty that addresses and tries to even out the nasal tip. Be sure to see a rhinoplasty expert for consultation.

Hi, It is better for you to consult with your facial plastic surgeon who can examine you and give you opinion based on examination. It can be fix with revision tip-plasty to correct asymmetry and the droopiness.

You're right—the nose can change with time, and it’s not uncommon to notice subtle shifts years after a rhinoplasty, especially after being happy with the results for so long. Based on your photos, you have thinner skin, which can make these changes more visible. A tip rhinoplasty would help address the hanging columella (particularly noticeable when you smile) and the tip asymmetry. Given your thinner skin, there’s less room for error, so an open approach may be the best option to allow for direct visualization and precise reshaping of the cartilage.

Dr. B.

Based on your photos, you appear to have very thin nasal skin which is associated with the shrink wrap phenomenon. This is when the skin retracts down onto underlying cartilages and there can be an asymmetrical and pinched nasal tip appearance. In our experience, microdroplet Silikon-1000 injections may be helpful for achieving a less operated nasal tip appearance by restoring lost nasal tip volume. Thank you for this question. Sincerely, Dr Joseph

The main problem I see is that your tip droops too much. This is very a common cause for revision rhinoplasty. It may not have been shortened originally which I commonly see but is simple to correct. I think that would improve the nose considerably

I can see precisely what was done with your nose and what we need to do to repair it. We'll need to restructure the cartilage and reduce sharp areas. This can certainly be done without addressing the other areas.

It is possible to undergo a tip revision. The area you are concerned about can be repaired. The cartilage can be resected or repositioned. It appears to be due to buckling at the junction of the lateral cruras and medial cruras.

Best Wishes,

Gary Horndeski, M.D.

Hello and thank you for your question. Based on your photographs, nasal tip deprojection is the best procedure to accomplish your goals and improve your tip symmetry while adding tip support and tip elevation. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Recommendations on best approach for a revision rhinoplasty are largely dependent on a full examination with your surgeon. Asymmetries in the nasal tip are often caused by asymmetries in the lower lateral cartilages of the nose. These can be controlled with a variety of suturing and grafting techniques. Whether it is best to address the tip alone or a more holistic approach is dependent on overall nasal symmetry and internal examination. Deviation of the nasal tip is often associated with deviation of other structural components of the nose, which if not addressed may lead to persisting asymmetry after revision surgery.