Help! Is there any hope that my nose can be fixed/symmetrical? My tip is awful. I've had two surgeries already (Photo)

What can be done to restore my nose? Revision rhinoplasty specialist candidates? I need revision rhinoplasty for the second time, is there any hope?

Doctor Answers 11

Revision rhinoplasty

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Hi there,

Thank you for your question. 

The septum is both crooked and unstable. You're definitely going to need a rib graft to reconstruct a straight, stable septum. Once that is done, the tip can be worked upon to make it straighter and a better shape.  Your skin envelope looks fine.

The way forward it so consult with rhinoplasty specialists who can advise you and undertake the surgery.

All the very best.

Howard Webster

Plastic Surgeon

Revision rhinoplasty

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Revision rhinoplasty can typically improve asymmetries in tip and nostrils.  Typically cartilage grafting from ear and/or rib is needed to give more support to the nose.

Tip Rhinolasty Revision Candidate

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Hi Ashley, based on your photos provided, it does appear you are a candidate for a revision tip rhinoplasty procedure. It looks like you will need the entire tip rebuilt. Take a look at my website gallery to get an idea of what type of change is realistic. You can also take a look at my Instagram @drhilinski to see a few recent examples of similar deformities that I operated on involving the tip and soft triangle region.

John M. Hilinski, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 44 reviews

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Revision rhinoplasty

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Hi there, thanks for sharing your question and photos.  Your nasal tip appears to have a bit too much cartilage, causing twisting and asymmetry of the tip.  This is usually corrected by making the tip cartilages more symmetric and less protruding.  This will also help to match the tip to the rest of your nasal bridge better.  Of course, a third operation is always challenging so please be sure to speak with some surgeons with surgical experience in this area.  Best of luck to you!

Tom D. Wang, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 29 reviews

Nasal tip revision. Considering a third surgery

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Hi there, thank you for posting your photos and question. I can understand your frustration and disappointment as you consider a third surgery. Although revision surgery is certainly harder than primary surgery because of the scar, anatomy, and limited available material, I do think your nasal tip can be improved. My recommendation would be to seek consultations in your area from a few surgeons. It will be helpful to have your old operative reports (the surgeon's office can call to get the reports from your prior surgery with your permission). You will need to discuss what material will be used to reconstruct the nose to make it straighter. Rib cartilage can be an option (either yours or donated). Waiting until a year after your last surgery before a third surgery is advisable. By waiting you make sure your healing is at its best for your next surgery, you don't want to operate on inflamed tissue that will respond by creating more scar. Hope this helps. When you are ready talk to a few surgeons.

Myriam Loyo, MD
Portland Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Probably your nose can be improved a lot. See the morph I made.

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Click on the "Web reference" link, just below my response, or go here:

I made a computer morph of your nose, and an animation of the morph, to show the changes that are likely possible for your nose in truly expert hands.

In the morph, I elevated that droopy, angulated piece at the bottom of your nose, I raised the tip even more, and I brought the entire nose back closer to your face.

Of course, I haven't had the chance to examine you in person, but the photos seem to indicate that there is still adequate cartilage left in your tip, especially if one of the goals of the operation is to make the tip and the entire nose look smaller.  To my way of thinking, large grafts, such as rib grafts, are used if a nose is waaaay too small, and we're trying to make it look bigger. But in a case like yours, there are various deformities that we would like to correct or minimize, and making the entire nose smaller is one way to minimize the deformities: when the whole nose is smaller -- closer to the face, or shorter, with the tip up -- then any remaining asymmetries or problems also look smaller. Hope I explained that well enough.

So, with a nose like yours, I'd think about making the nose smaller, so it doesn't draw attention, and correct as many of the problems as can be corrected at the same time. I'm curious what you think of that philosophy for your nose, and what you think of the morphs.

You'll see, on the frontal morph, that I didn't correct all the asymmetries. I don't think that's possible. The goal from the front would be to raise the tip, narrow the tip, make whatever corrections of asymmetries the nose will allow, and in general, once again, just make it so it doesn't draw unwanted attention.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the sections in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon, and how to tell whether your primary surgeon should perform your revision.

Your nose is also a good example of why computer imaging 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. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer. 

Revision rhinoplasty

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You will need a revision rhinoplasty and should wait a year before committing to another one.   You would have to be examined in person to determine what the tissues are like, and your goals of surgery.

Revision Rhinoplasty Expectations

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I encourage you to consult with a revision rhinoplasty specialist; reconstruction of the tip and mid-portion of your nose will be challenging but significant improvement can be achieved which will make it worth your time and money. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

help! Is there any hope that my nose can be fixed and made more symmetrical? I've had two surgeries already

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A tertiary revision  rhinoplasty is a very difficult procedure in light of the fact that there is already extensive scar tissue, significant asymmetries, and previous alterations to the normal nasal anatomy. It's important to have reasonable expectations forward about what can and cannot be accomplished with a revision rhinoplasty procedure. Revision rhinoplasty is the hardest operation to perform correctly in the entire field of cosmetic surgery, so it's important to choose your third surgeon based on extensive experience. In addition, an in-person examination is required to make a determination about what can be improved and also see about how much cartilage is left on the inside of the nose for potential grafting purposes

Revision rhinoplasty for the very asymmetrical tip etc.

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Revision rhinoplasty for the very asymmetrical tip etc. Yes you can have a much better tip! See a very experienced revision rhinoplasty surgeon who can show you photos of results on noses like yours. In my opinion after more than 35 years since pioneering "open rhinoplasty" in this country this is a perfect example of a nose that should be done open.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 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.