A Rhinoplasty Revision: Nose Looked Good and Now Its Bigger then when the Cast Went off, Why?

Hey, I would like to ask doctors and rhinoplasty patients: i am 3 and half month after the nose job. when the cast went off my nose looked good. but now its all crooked and the tip is bigger and definately not straight.it was a revision rhinoplasty. but i guess its scarring. my surgeon does not admit its crooked and says everything is just fine. its not. do you think that my nose will look better? is it possible for scarring to disappear?

Doctor Answers 3

What nose looks larger than when cast was first taken off

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There can be some rebound swelling once the cast is removed after rhinoplasty (especially revision rhinoplasty). Also, the swelling may seem even more evident as the tissue edema partially resolves (especially the upper 2/3rds of the nose) and the tip remains pretty swollen.

The crookedness you're now seeing may be because the initial overall edema was hidding the relatively more sublte asymmetry. It's too early to say how things will look in the end and whether another revision could be done to make it straighter.

Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Changes in appearance following rhinoplasty.

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You raise many good points about the evolution of appearance following rhinoplasty.  Most of what you describe is likely related to gradually decreasing edema as the excess tissue fluid that accumulates following surgery dissipates.  The swelling present shortly after rhinoplasty tends to camouflage any asymmetry, irregularities or contour abnormalities in the underlying cartilage framework. If present, these unpleasantries are slowly revealed as the swelling resolves.  In addition, cartilage grafts which are commonplace in revision rhinoplasty can warp over time.  Finally, the natural tendency for the soft tissue envelope is to contract over time which may push or pull the underlying cartilage into unfavorable alignment.  In my experience, at 3 months the general outcome of the surgery is visible.  If asymmetry or a crooked result is present at this time then future changes will likely not improve the result.  It is wise to remember the following adage during rhinoplasty surgery.  If the nose leaves the operating room looking perfect, then it has a chance of looking good several months later; if the nose leaves the operating room looking less than good, it has virtually no chance of looking good when all the healing has finished.

Regarding the appearance of a "bigger" tip over time, this may in fact be due to the fact that swelling in the areas around the tip dissipates much more quickly than in the tip itself.  Over time the relatively big appearance of the tip is one aspect that is likely to improve for several months following rhinoplasty.

My recommendation is to visit with your surgeon and ask that high quality standardized rhinoplasty photos with proper lighting be taken.  I would then analyze the photos together with your doctor. You can superimpose a reference line through the midline structures of the face and see how the nose lines up relative to these.  The photos don't lie.  If your surgeon is unwilling to do this then it’s time to seek out other opinions.

As to whether another revision is a good choice or not is another matter.  It may be that the current result is a significant improvement and within reasonable expectations for a revision rhinoplasty.  It is well known that chances of hitting a home run are inversely proportional to the number of revisions in rhinoplasty surgery.

Mario J. Imola, MD, FRCSC, FACS.


Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 124 reviews

Post rhinoplasty results

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Nasal Results post-rhinoplasty do go through some changes over time.  You need to give it about a year before seeing the final results.  Crooked noses even when straightened tend to stay  a bit crooked.

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