Is this a complex revision rhinoplasty? Seeking advice on tip support and alar base. (Photos)

Question

Hello, I am seeking expert opinions on a possible revision rhinoplasty. I have attached my photos for reference (the first photo is the pre, the second is the post). In my opinion, the primary issue is not fibrosis/scar tissue, but rather a lack of adequate structural support in the tip, combined with an uncontrolled alar base. These issues seem to be further accentuated by my thick skin. Does this look like a particularly difficult revision? I would appreciate your thoughts on whether improving the tip projection and stabilizing the alar base could achieve a more refined result despite the skin thickness. Thank you.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Additional photographs, including a true lateral side profile view would be very helpful to give you the best and most specific advice. Here is some generalized advice when considering a revision:

I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up.  Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results with standardized lighting and standardized background. If your surgeon is posting mostly on-table results without real long-term follow up results, that is usually a major red flag.  If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, or all patient selfie’s without real longterm in-office formal pictures that can also be a red flag.   Long-term results are much more meaningful than on table results or 1 week post-op results. Selfie’s can also be fun to look at, but these can often have a filter and do not represent true longterm results because of this and are not as valuable as real longterm in-office before and after photographs on your surgeon’s website with standardized lighting and standardized backgrounds.

I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Is this a complex revision rhinoplasty? Seeking advice on tip support and alar base. (Photos)

Answers (1)

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