Revision rhinoplasty for nostrils, notching & nose tip? (Photos)

Hi @catcaity. Thank you for sharing your photos. I recommend seeing an expert revision rhinoplasty specialist for an in person examination. There are several options for you that can be determined after examination. In my practice, I utilize piezosurgery. Piezosurgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezosurgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures.

Best of Luck,

Dr. Nima

Thank you for your question and for the photos you provided. Since you’re unhappy with the result of your initial surgery, you may be a candidate for a revision to address the features you’re referring to. During revision rhinoplasty, the nostrils can be narrowed, the tip can be resized and lifted, the notch assessed, and the overall symmetry of your nasal shape taken into account.
Please note that each subsequent nose surgery becomes more complex due to the loss of structural support, scar tissue, and other factors. The importance of experience, expertise, and artistry cannot be overstated. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon with expertise in revision rhinoplasty techniques. They will be able to review your surgical history and assess your concerns to determine the best way to help you achieve your aesthetic goals.

First of all, thanks for your question. Unfortunately, such unwanted results can occur with some rhinoplasty techniques. However, it would be best if you had a comprehensive revision rhinoplasty surgery to fix these significant problems. When I evaluate your photos, I see you have a wide dorsum, an open roof deformity, and a pinched nose. However, these diagnoses should be clarified after a detailed evaluation. When we do the necessary processes for your nose with the proper technique, the problems that arise in your first surgery will be fixed. I wish you an amazing day!

The primary goal of your revision, as I see it, would be to shorten the nose, which means raising the tip. Whatever nostril work is possible would be done at the same time, but the majority of the work would be the shortening. The good news is that, even though it takes complex techniques, especially in a revision, it does tend to be one of the more predictable changes we can accomplish in a revision.
How *much* to elevate the tip, or deproject the nose, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

I'd love for you to see some excellent morphs of what could possibly be done with your nose. It might make you feel better about the possibilities. Morphs help you plan your ideal goal, and help the surgeon understand what you need in order to be happy, and correlate that with what he thinks is possible in his hands.
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.

Don’t do revision rhinoplasty. You have thick skin and it is not possible to define it any further. The notching is barely visible.
Revision rhinoplasty has a higher risk of complications than primary rhinoplasty. Your deformity is not significant. Although it can be helped with revision rhinoplasty, the risk to reward ratio is not good. It will be best to leave it alone. However, you have to make that decision depending on your personal preference.

Regards
Dr. J

Much more information is needed, such as a full set of facial photographs from all angles, since the nose is a three-dimensional structure. You also Have thick skin in the tip of the nose which is going to prevent refinement in that area. Revision rhinoplasty is more difficult than of primary rhinoplasty, so it's imperative to have realistic expectations. There is no perfect nose, just improvements A copy of the operative report would also be helpful to understand what maneuvers were performed in the first surgery.

Good Morning! Thanks for your questions and excellent photos. Those are very helpful. I can see what you're referring to. The asymmetry in the bridge and midvault can often be fixed with grafting - either cartilage or soft tissue. The tip may need to be refined and lifted. Repositioning the tip on a strong caudal septal extension graft can do wonders. Nostril width and flare can be adjusted via a base reduction being careful to not overdo-it as correction can be very difficult. As with any revision, there is a risk of creating new problems (although low). I would seek consultation with other surgeons if you're comfortable to gather more information. Best of luck!