I'm 14 months post-op open rhinoplasty, have I had a bad result? (Photos)

Question

I had an open rhinoplasty 14 months ago. I have thick skin and wanted a more defined less bulbous tip. My nose looks much better from the side but from the front there is not huge improvement. Could i Still have some swelling? When i wear a nose clip my nose looks better after. Do i need wait longer for final result or is this as good as it gets? Should i get massaging and using my nose clip?

Steven M. Denenberg, MD · Answer

The nose clip, or massaging, cannot make a long-term change in the appearance of the nose. As you suspect, after 14 months, whatever width remains is just overwhelmingly likely to be the cartilage in the tip of the nose, and maybe some scar tissue, but not residual swelling that will eventually resolve and make a fine tip. Sorry.

Especially considering how wide the tip was before surgery. It looks as though the techniques used to narrow the tip weren't up to the job. The good news is that, if indeed it's the cartilages that are still keeping the tip wide, it should be possible to make a very large improvement in a revision.

How *much* to narrow the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, 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. 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 it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have an excessively wide nasal tip appearance on front of you given what you started with. Please visit your surgeon to answer this question. Are you still swollen? If the answer is yes, perhaps a dilute steroid injection might be considered. If he or she is uncertain, please consider getting a copy of your operative report and getting a second opinion. Thank you for this question, and I wish you well moving forward. Sincerely, Dr. Joseph

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can see from your photos You definitely need to have a revision operation, I recommend you a revision operation to get rid of this image.
It would be better face to face consultation.
Best regards!

Jacob Tower, MD · Answer

Hello, hope you are well. Thank you for posting your photos and questions! For the vast majority of patients who have undergone rhinoplasty, their results are considered 'stable' by 14 months after surgery. In other words, I would not expect much further change to occur spontaneously by this point (healing, reduction of swelling, etc). Improvement can be appreciated in your before and after photos, but it is understandable that you would hope to see further reduction in size and refinement of shape in the tip. I do not believe that nasal appliances (clips, molding devices, etc) or massage could be expected to help much. The hard truth is that the most direct way to address this issue would be with revision rhinoplasty with cartilage and/or skin-soft tissue envelope reduction (debulking).
Best,Dr. Tower

Ronald J. Edelson, MD · Answer

It appears your tip is overly bulbous and this could be corrected with a revision to remove excess cartilage in your tip.

J. Renee Booth, MD · Answer

There seems to be improvement after the nose clip is applied. The clip seems to be molding the skin in a desirable manner. I think it is reasonable to consider having radiofrequency microneedling (such as Morpheus8) to tighten up the skin. Another treatment that can be used either before or after that is the Halo Erbium YAG laser. Both of these treatments use heat to tighten up the skin. If the shape of the skin continues to be an issue after trying those, the surgeon could remove (debulk) some of the soft tissue on the underside of the nasal skin, but that would require another surgery.

Mats Hagstrom, MD (license on probation) · Answer

Rhinoplasty surgery is not a single operation. It is an umbrella of many different procedures to change the appearance of the nose.
Plastic surgeons usually subdivide the nose into individual anatomic subunits.
During your consultation was nasal tip surgery part of the plan?
Did the provider show you before and after pictures of what your nasal tip would look like? if so, I suggest you go back to your provider with before and after pictures and hand and ask them to show you the same pictures you reviewed during your consultation.
Without having full context of what the plan of the procedure was, can’t really address your concern.
If the procedure was going to include reducing your nasal chip, then your procedure did not accomplish that.
 go back to your provider and talk to him or her about your concerns.
Best,
Mats Hagstrom, MD

I'm 14 months post-op open rhinoplasty, have I had a bad result? (Photos)

Answers (7)

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