What to ask for at revision? Pollybeak? What would you fix? (Photos)

Based on your photos, your tip has generally thicker skin so it will always look a bit heavy, To really make a good assessment, we should see photos from before your first surgery. The photos here show some supratip and upper 1/3 fullness that can be taken down, and a tip that can be better projected. These things would be best done under general anesthesia. Be sure to see a rhinoplasty expert for consultation.

If your doctor was giving you a hard time about revising your nose, it may be that he is uncomfortable with your situation. You appear to have a wide nasal tip appearance with flaring nostrils, along with a hanging columella and a polly beak, as you described. Since you're columella maybe associated with a long nasal septum, septal shortening and septoplasty may need to be considered, and this would require general anesthetic, in our opinion. If you have any concerns that your doctor is unable to address what you enumerated in your narrative, please consider getting a second opinion from a reputable rhinoplasty specialist. I hope this helps, and I wish you well moving forward. Sincerely, Dr Joseph

Hello and thank you for your question. Based on your photographs, you will benefit most from a revision rhinoplasty with general anesthesia. I don’t think local anesthesia would accomplish a good result here. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. The alar retraction needs to be corrected as well. 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

The photographs you presented demonstrate residual dorsal hump, and a significant hanging columella. Trying to perform this revision rhinoplasty under local anesthesia would be very painful and you would not tolerate it. It's best to do this under general anesthesia. Revision rhinoplasty is more difficult than a primary rhinoplasty, so choose your second surgeon very wisely based on extensive experience. All of this can be performed with a closed rhinoplasty approach with all of the incisions placed on the inside of the nose. No external incisions, and no painful packing is required either. Digital computer imaging would also be helpful to understand what can cannot be accomplished with your nose upon your facial features.