Problematic healing after rhinoplasty. Is tip plasty an option? (Photo)

Question

I had septorhinoplasty in Oct. 2020 to correct a bulbous tip and dorsa hump. I developed a callous on my bridge and went in for rasping in June 2022 (same doctor). I'm experiencing swelling in the primary area of rasping that's only gotten worse since the summer. My doctor is aware and advises against steroids until June 2023. Also, I feel like my tip is still bulbous and overprojected, but I can't tell if it's related to swelling. Is this normal? Is a tip plasty an option?

Steven M. Denenberg, MD · Answer

How much of the bump is hard, and how much can you squish/compress easily? If it's *all* squishy, then it *should* come down a bunch. Same with the width of the tip: if the tip width is cartilage, then probably you'll need a revision for that width. I guess I'd bet the tip won't change dramatically, because, theoretically at least, the strength of the tip cartilages, besides making the tip wide, holds the tip out away from the face in projection, and also holds the tip down, making the nose long. I guess I'd elevate the tip a bit at the same time as deprojecting and narrowing it.
How *much* to elevate the tip, or deproject the nose, or narrow the tip, or make other changes? 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 better just 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 really 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 the surgeon has that information and judgment best.)
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.

Arturo Munoz Meza, MD · Answer

Lo que si va a necesitar es dejar descansar a los tejidos, ya que han sido trabajados "ineficazmente", relativamente pronto. descarte el uso de esteroides, eso solo le hara la piel del area mas delgada y fragil y dificulatara el acceso al dorso para remover la jiba residual cercana al radix que quedo(no es que le haya "salido", simplemente mientras estaba hinchada, no se notaba). Lo mismo se puede decir respecto a la punta nasal, se puede revisar, SI, mas programelo con alguien que realmente sepa del manejo de punta bulbosa y de preferencia con abordaje endonasal(sin cicatriz visible en la columela).

William Portuese, MD · Answer

Your bulbous tip maybe related to thick skin, which cannot be changed with a rhinoplasty procedure. You appear to still have a dorsal hump which is composed of both bone and cartilage. A Surgical revision rhinoplasty can be entertained, only after waiting a year from the last procedure

Problematic healing after rhinoplasty. Is tip plasty an option? (Photo)

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Problematic healing after rhinoplasty. Is tip plasty an option? (Photo)

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Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.