Potential revision with same surgeon - tip definition, nostril adjustment and slight deviation? (Photos)

Question

Hello, I’m 25 years old (I was 23 when I had my surgery in January 2023) and I’m Middle Eastern. I’m 5’1 and 115 lbs. I’ve included photos of my original nose. My main concern before surgery was my side profile, which we did improve. For my original surgery, I was shown three options for length. I chose the middle option, but my surgeon had initially planned a slightly longer version. At the time I was very insecure about my nose being too long, so I went shorter. Now I sometimes wonder if the slightly longer option might have looked better from the front. Currently, my concern is that my nostrils look wide from the front (especially when I smile), and there is a slight deviation. My surgeon has offered a no-cost revision to slightly define the tip, minimally adjust the nostrils, and fix the deviation. I’m scheduled to have the revision in May of this year, and I will be 26 in 2026. I’m feeling anxious because my front view wasn’t a big issue before my first surgery, and I don’t want to make things worse or end up with something that doesn’t suit my face. I also had prolonged swelling last time (about 1.5–2 years, including a steroid injection), so I’m nervous about healing again. My surgeon says these are minor refinements, but I’d really appreciate any insight or similar experiences. I’m concerned with longevity and support in the future as well.

Steven M. Denenberg, MD · Answer

Do not have the revision. I only have your photos here and the story you posted, but I'll show you how I evaluate a situation like this. 
When we look at a nose for a revision, we consider:
What are we trying to change
How *big* is the thing we're trying to change -- because the smaller the desired change, the less predictable it is to get it right.
How *predictable* is it that we can succeed with each planned change -- shaving down a little remaining bump is more predictable than getting more narrowing of the tip, for example
What are the *risks* of trying to make the changes -- If the surgeon *only* makes the incisions, gets the skin up to see what's going on, makes *no* changes, and closes the incisions and puts on the splint, he is almost certain to have changed something, for better or worse, *and* he has started the clock over on swelling, no matter how minor the changes that he didn't do. Further, the body will heal by making more scar tissue, which can decrease definition here and there.
You got the profile changes you were seeking; that's great. The frontal view looks totally fine. Your nostrils perhaps, perhaps are more noticeable, but it's the rare person who will see that, and it's not unaesthetic. 
Let's talk about the deviation. That's in the frontal view, right? I can't see it. And even if I could, "correcting a deviation" is extremely difficult and not predictable at all. And "slightly define the tip"? In my universe that's not possible at all. The tip isn't putty, that you can just trim. And see my comments above about starting the clock over on the swelling, and the extra scar that would get in the way of more definition of the tip.
A revision is always a major, risky operation, and the decision whether to proceed must be made with care. It's never a small-ish thing, where if it doesn't succeed you're right back where you were. And your history of prolonged swelling settles the deal for me. Do you have the time and energy to look in the mirror and worry about swelling every day for the next two years, with no chance of getting more tip definition or deviation correction in the first place? Maybe just moving on would be something to consider.
Sorry, this sounds like a rant, doesn't it. Maybe with detailed photos, I would have a different idea, but I wanted to plant into your head the idea that we don't ever ever just do a revision because we see something that's not ideal.
Now, if the surgeon has a procedure to *only* narrow the nostrils, *without* opening the nose or making any incision in the nose or trying to correct anything else, that might be very reasonable. But you probably should go back to the drawing board before dancing into surgery. Posting your question here was a good idea, a good starting point.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a revision rhinoplasty. A surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. 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

Potential revision with same surgeon - tip definition, nostril adjustment and slight deviation? (Photos)

Answers (2)

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