My tip is over projected after a combination Rhinoplasty/ Chin Implant. Should I consider Revision Rhinoplasty? (photo)
Should I think about a revision rhinoplasty?
Doctor Answers 11
Revision rhinoplasty: Nose still over-projected and too long.
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.
Do I need a revision?
Nose still long after Rhinoplasty
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.
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Revision rhinoplasty for the over-projected nose
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.
Consideration for revision rhinoplasty
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
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.
You could possibly benefit from repositioning and reorientation of the nostril margins which are somewhat plunging.
Many people need a revision rhinoplasty
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.
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
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.