Big, Rounded, and Drooping Tip After Revision Rhinoplasty

I had a Rhinoplasty about a year and 6 months ago, and was very unhappywith the tip. 6 months ago, I had a revision Rhinoplasty done and was very happy with the results as soon as the cast came off. It had a little bit of a scoop, but I'm starting to notice that the tip is slowing moving downward and is no longer scooped as it curves down. It also seems like the tip of my nose is big and rounded. Is this swelling? What should I do?

Doctor Answers 8

Changes in the nasal tip after surgery

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At six months out from revision rhinoplasty, you may still have some mild residual swelling in the tip and supratip (area above the tip). You should bring up your concerns with your surgeon, as a steroid injection may be of benefit. Drooping of your tip could be related to inadequate tip support. There are several techniques for improving this through revision surgery (e.g. columellar strut, septocolumellar suture). However, I would recommend waiting for at least another 6 months before considering this. 

Rhinoplasty results take time

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When I perform revision rhinoplasty I tell patients that it will take at least a year (depending on skin type) for them to see the "final" results. That being said there are some things that are concerning that can occur before that 12 month mark. First of all if your tip is already drooping you may have inadequate support for the tip. This is unlikely to get better on its own. Time will tell how this will settle out. If the tip is still rounded this is less concerning as it could certainly continue to refine over the next 6 months. Keep going for your check ups and make sure that you give it the full 12 months before judging the outcome.

Revision rhinoplasty concerns

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Six months is a bit soon to determine what the end result of a revision rhinoplasty will be.  However, you are getting close to seeing what the ultimate result will be.  I am concerned that you may have lost some tip support which is contributing to the droopiness of the tip.  See your surgeon and discuss your concerns with him.

See your physician to fix your drooping tip, which may be a pollybeak deformity

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Without a full examination, it is difficult to know for sure what is happening. In general, all patients heal differently. Some patients may develop scar tissue and swelling at the tip area during the healing phase that can cause a pollybeak deformity. If this is the case, the swelling can and should be treated by your physician. I would discuss this with your treating physicians.  

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

Revision rhinoplasty settling of the tip

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More than likely this is settling of the tip, due to still weak tip cartilages, that is likely exacerbated by thick skin. Assessing you in person or at least by photos is the first step to making a plan to provide you with the most cosmetically desirable result, a procedure that would require a lot of experience to accomplish those goals.

Revising the nasal tip after revision rhinoplasty

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A revision rhinoplasty can be a challenging procedure because not only does the surgeon have to work to achieve your surgical goal, but they have to battle the scarring and possible deformity caused by the first surgery. Furthermore, every additional rhinoplasty is more difficult than the last. If you have had a revision rhinoplasty and are concerned about the size and roundness of your nasal tip, keep in mind that you will have a significant recovery process with swelling and in this area that you must overcome. Be sure that you are relaying your concerns to your plastic surgeon, use a cold compress to this area, and be patient until you reach your final results.

Big, round, drooping tip may be a polybeak deformity

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When too much of the nasal structure is removed it can result in such a deformity where the tip of the nose becomes full, round, and droopy.  There is a way to correct this with cartilage grafts such as in the case below (see link).

Drooping Tip

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I understand your concern. There are several possible explanations. This "Polly-Beak" type of deformity may be secondary to inadequate tip projection and support , or too much cartilage above the tip along the profile line. After having two rhinoplasties, it may take even longer for the post-operative swelling to resolve. I know it will be difficult, but be patient. Follow the progress with your surgeon or get a second opinion.

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