Revision Rhinoplasty advice? Can anything be done to make my tip smaller? (Photo)

Question

Middle eastern patient: 3 years post primary rhinoplasty (right photo after, left photo before). I went to one of the top rhinoplasty surgeons in Canada ($10k cost). My tip is larger than before, I don't see definition in my tip, and the sides of my nose flare out. My breathing has also been compromised with nasal valve collapse. My surgeon is not confident that anything can be done to reduce the size of my nose but has offered a revision. Can anything be done to make my tip smaller?

Jonathan Kulbersh, MD · Answer

I would need to examine you in person to know for sure. I can tell you that you might be a good candidate for revision rhinoplasty depending on why your nasal tip is wide. If cartilage is the issue, it can be surgically corrected. If thick skin is a problem, you will likely be limited in just how much correction you can achieve. Keep in mind that revision rhinoplasty is a highly complex procedure that requires even more expertise and experience than the original procedure. Choose a board-certified facial plastic surgeon who can show you many before and after photos of previous patients before making your selection.

Steven M. Denenberg, MD · Answer

If your tip is still wide because the tip cartilages are still in a wide position, and are controlling the width of the tip, then yes, those cartilages can probably be altered to make your tip narrower.On the other hand, if the tip cartilages are already in an excellent position, but the tip is wide because of some excess scar tissue, and possibly the thickness of your tip skin, then it would be more difficult to get some meaningful narrowing to your tip.The best way for a surgeon to tell is to have the opportunity to examine your nose in person. But it can be possible to get some information from better photos. With a full set, from all different angles, it can be possible to get hints about the current state of the nose. One view, like this frontal view you posted, just isn't enough.
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.
Your nose is also a perfect example of why computer imaging by the operating surgeon 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. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Stephen J. Pincus, MD · Answer

It is hard to say what the likelihood of improvement would be without an actual examination and a review of the operative report to see if grafts were placed around the tip or if scarring is the main cause of enlargement. I have seen situations like this where removal of cartilage grafts and excess scar tissue coupled with judicious use of steroid and 5-FU intra-nasal injections and taping/casting have worked quite well. You should seek consultations from surgeons adept at advanced techniques in revision rhinoplasty. Keep in mind that surgeons who may be quite competent doing a primary rhinoplasty may not be experienced enough to handle the pitfalls and challenges in many revision rhinoplasties.

Gary Linkov, MD · Answer

Revision rhinoplasty requires exceptional skill on behalf of the surgeon and great communication with the patient about realistic goals and expectations.
Common cosmetic concerns include a dorsal hump, wide nose, sunken nose, irregularities, and asymmetries. Functional concerns include difficulty breathing through the nose, which can and should be addressed at the same time as your rhinoplasty.
In a revision rhinoplasty, cartilage from your septum may have been depleted and therefore often an alternative source of cartilage is needed, such as from the ear. This is just one of the important differences between primary and revision rhinoplasty that need to be discussed in detail before you decide to proceed with surgery. 
In your situation, the tip does appear larger after the surgery. A revision procedure can help better sculpt the tip. 
Make sure to seek out the care of a board certified surgeon with extensive experience in revision rhinoplasty. Find someone you connect with, who will listen to your concerns and provide you with a framework for what is possible.  
Gary Linkov, MD
Rhinoplasty Specialist
Manhattan

William Portuese, MD · Answer

Much more information is needed, such as a full set of facial photographs from all angles, a copy of the operative report,  and your before  surgery pictures.   If the width of the nasal tip is related to thick skin, steroid shots may be of some benefit.  If the width of the tip is due to excess cartilage, then revision rhinoplasty may be helpful.  An in-person examination is going to be required to determine the thickness of the skin in the tip of the nose.

Sean Freeman, MD · Answer

Kind6565, you cannot get definitive answers without an exam. See an experienced plastic surgeon that specializes in only faces and performs on average over 100 rhinoplasties a year. see the video and good luck!

Revision Rhinoplasty advice? Can anything be done to make my tip smaller? (Photo)

Answers (6)

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