Revision Rhinoplasty for excess fullness in supratip area - what are my options? (photos)

I had my primary rhino last April Previously I had a small hump, hanging columella and bulbous tip. While the result is ok, I am not really happy with it Issues are 1) excess fullness in supratip area, NO change in the past 7 months 2) no supratip break, overall convex shape to tip (especially when smiling), tip shape too round in profile 3) columella still too large 4) overall projection too large (however I can live with the projection if I can change the shape) 5) bridge reduced too far

Doctor Answers 7

Revision for supratip fullness

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It is very difficult to answer your question without seeing you in person and examining your nose.  There are a number of criteria (such as skin thickness and strength of your nasal cartilages) that cannot be assessed by photos alone

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 229 reviews

Revision rhinoplasty options

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Thanks for your question and photos.
You have made a clear and accurate list of diagnosis of your problems.
There are multiple options and techniques available that can help you achieve a beautiful and natural looking result. It starts with in person consultaiton to review all your options.
Best wishes,
Dr Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Revision rhinoplasty

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You have made a very clear assessment of your concerns . I agree that you do appear to have some imbalance between the upper and the lower halves of your nose on the profile views with a relative deficiency above leading to a relatively heavy tip and supratip. The dynamic deformity that you describe when you smile may be due to the action of the depressor septae muscle or lack of structural tip support both of which should be correctable. There are several different approaches that could be taken to restore balance to your nose and you should consult with a surgeon who specializes in secondary rhinoplasty and who has imaging capabilities so you can determine exactly what you wish to achieve. It is always helpful to bring old photos from before the original operation as well as details of the previous surgery as this may have a bearing on your options. Secondary rhinoplasty is inevitably more challenging both for the patient, who has the disappointment of the original surgery and the surgeon who has to deal with damaged anatomy and scarring plus inherent anatomical problems. Choose carefully and take your time.

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Revision Rhinoplasty for excess fullness in supratip area - what are my options?

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   There are several maneuvers that could be utilized to give a more pleasing profile and may require a combination of maneuvers depending upon your goals.

Kenneth Hughes, MD

Los Angeles, CA

Revision Rhinoplasty

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I'm sorry to hear that you are contemplating a revision rhinoplasty.  It appears you have a detailed eye for analyzing the nose!  It appears that your concerns can be addressed and improved.  The best recommendation is to consult with a board certified specialist who can assist you with achieving the results you seek. 3-dimensional computer imaging can also help you visualize what you may look like afterwards and serve as a good communication tool with your surgeon.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Revision Rhinoplasty Options

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Hello Tiny, thank you for your questions and photos. Your analysis is excellent. Though I would need to see you in person to give exact recommendations, I believe that your primary issue is that the tip is over-projected.  Working backward from this, you can address the problem in multiple ways. In my opinion, I would reduce the volume of the tip cartilages and the height of the tip. The bridge may have been slightly over-trimmed.  This can be built back up with some cartilage or soft tissue grafts. Revision rhinoplasty is a very complicated operation, but the good news is that you're starting with a nice facial shape and some treatable issues. Please let me know if I can help you in San Francisco.

#San Francisco Rhinoplasty

Revision rhinoplasty

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Dear tiny_

  • Building up the bridge would also help with the supratip area to get a nice profile
  • We could reduce the projection just a touch as well for balance
  • I would have to see you regarding the large columella, do you mean it hangs too low?
  • I think your expectations are reasonable
  • Revision rhinoplasty is a complex operation, and we are subject to healing forces afterwards
  • When you are ready, visit a revision rhinoplasty specialist who can address all of your concerns

Best regards,
Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 84 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.