How Would a Pinched Tip and Wide Bridge Be Fixed in Revision Rhinoplasty?

Hello I had rhinoplasty surgery 2 months ago. I am unhappy with the result, although the nose looks okay from profile view, from the front the bridge looks too wide where the hump was removed and the tip looks pinched. I know the bridge may still be slightly swollen but osteotomies were not made during the surgery (the hump was just filed) and I can feel 2 boney bumps either side. I now do not trust my original surgeon so please could you tell me how this would be fixed in revision rhinoplasty?

Doctor Answers 2

How to fix a pinched tip and wide bridge with revision Rhinoplasty?

 I have performed Rhinoplasty and Revision Rhinoplasty for over 20 years and let me first say that your nose is not fully healed at 2 months post op from your original Rhinoplasty, so things could still change as far as the width of the nasal bridge.  The tip issues of being pinched may be another matter.  My advice is to have a conversation with your Rhinoplasty surgeon and see how things look in a few more months.  You would not be able to have a Revision Rhinoplasty, if you need one, until 6 months from the previous Rhinoplasty.

 If nothing about your nose changes from these photos...the nasal bones would be broken inward in order to make the nasal bridge more narrow and a tip plasty performed to re-shape the tip using conchal cartilage to the nasal tip for support and shape if required.

Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Revision rhinoplasty--how to avoid redo number three!

Thanks for including photos; your description is helped significantly by the photographs.

Your profile view shows a nice improvement, and by your description, you now have the same upper nasal width (plus swelling) as you had prior to your hump being rasped. The two bony bumps are the edges of the nasal bones that were reduced to remove your hump--this flat surface is called an open-roof deformity, and nasal osteotomies to restore your nasal pyramid (AND narrow the upper part of your nose) should have been done.

To be fair to your surgeon, osteotomies don't need to be done on every patient, but when a hump is reduced there is always some degree of open-roof deformity caused, ranging from minimal (especially if the rasping is oblique) to significant. This is always a judgment call by the rhinoplasty surgeon, but I have found that when in doubt, osteotomies are generally advised.

The pinched tip may mean a number of things, depending on what your surgeon did to the alar cartilages and how your healing is progressing.

Either way, you need to wait for 6-12 months to allow scar tissue to settle and soften, and during this time you should interview several ABPS-certified plastic surgeons with extensive experience in revision rhinoplasty, or ENT specialists in revision rhinoplasty. This is a straightforward re-do if thoughtfully and precisely performed, so do yourself a favor and choose your next surgeon carefully and follow all instructions. Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

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