My tip is over projected after a combination Rhinoplasty/ Chin Implant. Should I consider Revision Rhinoplasty? (photo)

I had a combination rhinoplasty / chin implant procedure about five years ago. However, it seems to me that my tip is over projected, and my nose overall seems too long.
Should I think about a revision rhinoplasty?

Doctor Answers 11

Revision rhinoplasty: Nose still over-projected and too long.

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An over-projected and overly long nose are some of the more common complaints following primary rhinoplasty.  From your photos I would tend to agree with your assessment.  It would seem that the tip is also somewhat down rotated which is contributing to excessive length.  In addition, you may benefit from adding to the upper third of the nose using a radix graft as a complimentary manouver to decreasing tip projection.  An in-person assessment is of course necessary to make precise recommendations and I would suggest revisiting the issue with your original surgeon if you feel comfortable, otherwise seek out an experienced revision rhinoplasty surgeon.

Denver Facial Plastic Surgeon
4.9 out of 5 stars 122 reviews

Do I need a revision?

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The profile view shows that some improvement may be possible for the lower portion of the nose. I could be more specific if you were seen in person. If you do not intend to go back to your original surgeon, you should request a copy of your op report and and pre-op pictures before seeing another surgeon. Bring these items along for a consultation.

Sheldon S. Kabaker, MD FACS
San Francisco Facial Plastic Surgeon

Nose still long after Rhinoplasty

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I agree that your nose appears to long (tip rotated downward) in these photos.  The tip appears to be at ~ 85-90 degrees and should be at approximately 105-110 degrees.  This could be done during a Revision Rhinoplasty by trimming the anterior/superior septal angle and using a permanent suture to rotate and secure the nasal tip.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

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Revision rhinoplasty for the over-projected nose

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Having had a rhinoplasty 5 years ago, the time is appropriate to consider a revision surgery if you are concerned that it is still too long. A reduction rhinoplasty can be done to make your nose smaller and less downward projecting. It does appear a bit long on the photos you have provided.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Consideration for revision rhinoplasty

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There are multiple reasons to perform a revision rhinoplasty that include shortening and deprojecting the nose.  The deprojection is done by trimming back some of the tip cartilage and the anterior most projecting septal cartilage.  The length of the nose is shortened by trimming the caudal septum and membranous septum.  All these procedures are combined to give a shorter and less projecting nose without making it look operated upon

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

Revision rhinoplasty

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From your photos, it actually seems that your tip projection is fine. The problem is one of nasal length, not projection. Some surgeons call this under- or counter-rotated. I think of it more in terms of length, although the two are related. Your nose would benefit from a little conservative shortening, while maintaining tip projection. If you are unhappy five years after surgery, it is certainly reasonable to seek a revision. My advice to you is to find a surgeon who is a rhinoplasty specialist and someone who is experienced with revisions. Select your surgeon carefully. 

Ryan Greene, MD, PhD
Fort Lauderdale Facial Plastic Surgeon
5.0 out of 5 stars 85 reviews

Revision options

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You could possibly benefit from repositioning and reorientation of the nostril margins which are somewhat plunging.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 229 reviews

Many people need a revision rhinoplasty

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Many people need a revision rhinoplasty, about 20% nationally I believe.  So yes, if you are still unhappy I think a revision surgery is a good option.  Make sure you go to a skilled surgeon as a revision surgery is more complicated then a primary surgery.  If you are near Beverly Hills feel free to call my office for a consultation.

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

Revision rhinoplasty

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Your tip is not over projected. Your tip is  rotated inferiorly and I would agree with you assessment that the nasal length is excessive. After five years if you are not satisfied a revision may be reasonable.

Should I have additional surgery

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After five years, there's no question that the result of your operation can change, as you mature. It is difficult to tell by your photographs the difference between your pre-operative and postoperative appearance. It is certainly worth the trip to see your surgeon to discuss your concerns. If he/she is not receptive, you should not hesitate to consult someone in your area who might be more understanding.

John E. Sherman, MD
New York Plastic Surgeon
4.4 out of 5 stars 15 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.