Primary surgery narrowed my nasal bones, and over-resected. Is this reversible? (Photos)

Question

Can I regain my old appearance with outward fractures, and raising of the bridge? In addition, a radix graft was placed that I never wanted, and my nose tip is now flat instead of hanging downward, all of which I did not want. As a result, my skin is now drooping, my eyes look sad, the lines forming the eyesockets have disappeared, and overall I just feel horrible. This nose is not me. My lip also slightly changed shape, and I just look sad and sickly and like a kid all the time now. I would like to regain the wide nasal base but also the high dorsal hump, longer nose, with a wider tip, and above all, a flexible nose tip. Is there any hope for me?

Guray Yesiladali, MD, FEBOPRAS · Answer

Hello. Thank you for the detailed description. Full face photos are important because some of the feelings you describe can come from midface volume and malar support as much as from the nose. After rhinoplasty a mild midface deficiency can read as a sad or tired look. A global facial analysis is wise before any revision decision.
Assuming the main driver is nasal change the outline below can help frame next steps.
What is likely going on• Radix looks overbuilt which shifts light higher and can shorten the look of the nose• Bony vault may be wide after prior fractures with lines that do not taper smoothly• Tip support seems reduced which can feel flat rather than softly defined• Base width may have been narrowed or the alar base may simply look narrower after the dorsal change
Will time fix it• At this stage shape is mostly stable• Small changes in swelling will not recreate a strong hump or longer tip on their own
Nonsurgical options while you decide• A very cautious filler trial at the dorsum or supratip can preview line placement and help decision making. This is camouflage not a structural fix• Skin care and photography tricks can soften contrast while you plan
When a revision makes sense• Persistent dissatisfaction with contour after month 12 to 18• Airway is acceptable or can be supported during revision• Goals are defined in terms of length line and base rather than a perfect copy of the old nose
What a revision usually involves for this pattern• Reduce radix volume to reset the starting point of the dorsal line• Rebalance the bony vault with controlled osteotomies to create smooth lines that narrow toward the tip• Recreate dorsal height with a structured cartilage onlay when a high profile is desired. This restores the visual hump in a controlled way• Restore length and projection with a septal extension graft or a columellar strut depending on tissue needs• Aim for a tip that feels supported yet not rigid by tailoring graft thickness and suture plan. True flexibility and stable support must be balanced• If the base is too narrow and prior alar base work was done small composite grafts or limited base widening can help• Support function with spreader or alar rim grafts as indicated• If septal cartilage is limited plan on ear or rib cartilage. Rib is chosen when strength and length are required
Expectations and timeline• Swelling over the dorsum and tip is expected for months• A new baseline is seen by month 6 with refinement toward one year• The goal is harmony at rest and on expression rather than a literal return to the exact preoperative shape
Smart questions for your consultation• Which element is primary in my case. Radix volume bony vault width tip support or base width• How will you reset the radix and define the dorsal line• Which cartilage source do you plan to use and why• How will you balance tip support with a natural feel on touch• Will you need spreader or rim grafts to protect breathing• If my base was narrowed before what are the options to restore width• How will you assess whether midface support contributes and do I need any adjunct treatment outside the nose
If you would like a case specific view standardized front oblique profile and smiling photos plus a short summary of prior surgery allow a tailored plan before any medical evaluation. Coordinators can help collect these details through a short complimentary conversation.
Wishing you clarity and a result that feels authentic to you again.Güray Yeşiladalı, MD

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, many of your imbalance issues with your nose could be addressed with nasal tip deprojection. With good surgical technique, you could have an outstanding result. 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

Best wishes and good luck.

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

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