Two Revisions to Fix my Tip and It Looks Even Worse. Can my Nose Be Fixed?

My first surgeon destroyed my (very nice, I thought) tip during open rhinoplasty to remove a bridge bump and fix a deviated septum. He tried to revise it using ear cartilage, but it remained under-projected and blunt. Now I am 4 months post op from a closed revision with another surgeon, who used rib grafts to build up the tip and fix a scoop. The rib warped and now I have a crooked nose and a large, round tip. I am scared to have a 4th surgery, but I hate my nose. Is there hope?

Doctor Answers 7

Another revision surgery

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Sorry to hear about your experience - the good news is that there is a solution to your problems.  Wait the appropriate time period and seek an experienced rhinoplasty surgeon, preferably someone doing 200 rhinoplasty procedures per year and with at least 10 years of experience

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Poor Nasal Tip Despite 2 Revisions

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Despite your previous unfortunate experiences, in the hands of one of the elite revision rhinoplasty surgeons in the U.S., you can achieve improvement in your nasal tip. Warping is a possible complication when using rib cartilage. Wait at least a year; the tip swelling will improve - you're only 4 months post-op.  

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Repairing revision rhinoplasty results

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A lot can be done with revision rhinoplasty techniques to fix your nose. It is important to select the right surgeon. In your case you need one with experience with complicated revision cases and cartilage grafts.

Rib cartilage can be removed and recarved if needed. Your tip concerns cal also be address, although I would wait at least a year from your most recent surgery before proceeding.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Revision Rhinoplasty is a quantum level more difficult

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Oh, I am so sorry to hear this.  Yes, rib cartilage, banked cartilage and bone in IMHO all have the potential to warp or dissolve unevenly and I don't use them in Rhinoplasty or Revision Rhinoplasty and haven't for over 20 years.  Revision Rhinoplasty is a quantum level more difficult, than primary Rhinoplasty because often to much cartilage or bone has been removed previously, things are asymmetric, support is lost, there's excess scar tissue and the nasal tissues themselves are just plain hard and difficult to elevate.

 First off, you can begin to have consultations with well experienced Rhinoplasty surgeons with good reputations but you really shouldn't have another Revision Rhinoplasty until at least 6 months from the last one and you really want this to be your last.  I have been the plastic and cosmetic surgeon who was performing the 10th Rhinoplasty on a particular patient and have been the 4th on many occassions.  I always make a verbal contract with my Revision Rhinoplasty patients that this will be their last.  Rhinoplasty at this point will not give you your old nose or tip back and you must come to grips with that reality before having any further surgery or the next Rhinoplasty could make things worse, much worse.

 The goal of this next and last Rhinoplasty should be and has to be to make your nose look as normal, symmetric and attractive as is possible with what you have right now....not what you started with. 

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

Rhinoplasty revision

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A rib graft can warp and curve. SOmetimes it is as simple as taking the graft out and correcting the curvature.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Two Revisions to Fix my Tip and It Looks Even Worse. Can my Nose Be Fixed?

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Yes, you have hope. Don't  focus so much on the procedure, but on the surgeon. 

Without photos it is hard to comment, but your chances of getting a good resolution are improved if you find the right surgeon. Concentrate on an experienced rhinoplasty specialist. Did your previous surgeons concentrate their practice to rhinoplasty? and if so, did they have enough experience with rhinoplasty surgery?

There are many surgeons with these qualifications, interview them and ensure that they have experience dealing with cases like yours.

Best of luck,


Michel Siegel, MD

Michel Siegel, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 113 reviews

Best answer for your Revisionary Rhinoplasty dilemma

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Unfortunately, this is a relatively common situation.  Noses can sometimes heal in unpredictable ways.  A solution is possible.  In my experience, the best approach for your situation is a revision with the open approach, since the original was an open approach.  Also because the best access to the tip is achieved by the open approach.  Rib graft may or may not be the answer on the revision (if it is then your own rib is ideal).  You may have enough cartilage in your nose already to reconstruct.  It is impossible to tell you exactly what is necessary without some photos, and ideally a physical exam.  Either way you should wait at least another two months to allow for swelling to improve and scar tissue to soften before additional surgery.

Leif Rogers, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 26 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.