Is my nose tip still swollen 1.5 yrs after open rhinoplasty? What can I do to achieve a smaller tip?

Question

Hi all! I'm about 1.5 years out from my primary open rhinoplasty. I like my results, but I still don't LOVE my nose. The tip of my nose is bigger than I would prefer still. I got a steroid injection about 5 months ago hoping that would help but the tip is more bulbous from the frontal view than I'd like. Does it appear I still have swelling in the tip? If not, what are some options that would be good for me to consider to get a smaller nasal tip? Tip plastic? Or even alar plastic?

Ronald Schuster, MD · Answer

Overall it appears that you have a very nice result. The tip looks like it might be just a bit over rotated but not what I would consider bulbous. You probably need to go for a real consultation to discuss your possibilities. Good luck.

Steven M. Denenberg, MD · Answer

Specifically addressing the width of the tip from the frontal view, how much more can be done depends on exactly the current size/shape/position of the cartilages. More detailed photos, especially some different three-quarter angles, could probably give good information about the tip cartilages.
There is a clue: on your profile, that nice "scoop" is there because the tip is strongly projecting beyond the line of the bridge. That strong projection suggests that the tip cartilages are strong, giving a conclusion that they perhaps could be modified to be less wide. From the front, it seems that your bridge might benefit from being narrowed if the tip is narrowed as well, to keep things in balance. My two cents.
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.

Ronald J. Edelson, MD · Answer

I agree your tip is too prominent. It would help to know if you had a cartilage graft in your tip which could explain why it apoears too large or hard. Simple to remove the cartilage graft if you wanted

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! If it's been 1.5 years after first time surgery, you're probably pretty close to the finalized result. Options at this point would be nightly taping, compression of the tip, and steroid injections. If these don't make any difference, then it could be time to consider a revision procedure. The front view is the slowest to improve compared with the profile. With any revision procedure, there are risks associated such as creating a new deformity; so, consider it carefully. Re-visit with your surgeon to discuss the best course of action. Hope this helps!

Robert Ciardullo, MD · Answer

Your nasal tip: your nasal tip does not look wide to me in relation to the other dimensions of the rest of your nose. Further steroid injection and/ or further surgery may make the tip angle slightly more upward, and it already appears to be slightly too high. I would therefore suggest you leave well enough alone.

Is my nose tip still swollen 1.5 yrs after open rhinoplasty? What can I do to achieve a smaller tip?

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