Just over 6 months post op, many issues, how well can a revision fix them?

Hi,Seems to me that the main issue to address is the length of your nose. The tip really hangs down. See the Web reference link for a modification that I made to one of your images, showing a rather significant shortening of your nose -- elevation of the tip.Elevating the tip of the nose is a change that requires quite advanced techniques, and most surgeons don't do a very good job at it; a too-long nose is one of the most common complaints of my revision rhinoplasty patients.Your frontal view also shows that the tip of your nose hangs down much farther in the after photo than in the before photo.In the modification, perhaps you can also see that I lowered the height of your dorsum a little bit. So I don't think that too much was taken off in the first operation. The other areas that you point out can be addressed to varying degrees in a revision: smoothing out the dorsum, hiding edges of bones, lessening an inverted-V deformity. I think you are a very good candidate for a revision, in the right hands, of course.You absolutely need to see before and after photos of revision operations from the surgeon you are considering. That is the only proof of his skill and abilities. Remember that board certification diplomas mean nothing at all in this arena.

A revision rhinoplasty may be able to help improve many of the issues and concerns you have.  However, it is best to allow complete healing to occur before undertaking additional surgery.  We recommend waiting one year for most patients seeking revision.  In your specific case, you will likely benefit from additional cartilage grafting and repositioning to the bridge and tip of your nose, in addition to gaining addition support for the tip.  Of course, the relatively large skin envelope will be a limiting factor in terms of amount of refinement achievable.  Please be sure to consult with a surgeon specializing in revision rhinoplasty for your next procedure.

 A revision rhinoplasty can be performed, but it is best to wait one year before embarking on a revision rhinoplasty until the entire healing process has taken place. It will also be important to know how much cartilage is left on the inside of the nose for grafting purposes during the revision. The tip of the nose can be lifted with  a tip rhinoplasty and cartilage grafts. Preventing the tip from drooping when smiling requires releasing of the depressor septi ligament. The inverted V. is treated with spreader grafts.  An open roof deformity of the nasal bones is treated with osteotomies. Thick skin will be an impediment to seeing a very refined result of the tip of the nose.

Well your nose did not come out well. Why is failed is difficult to answer. But you do have a "long skin sleeve"  which will tell and expert to minimize dorsal reduction. I don't know if the caudal septum was trimmed enough and the tip widely undermined to allow for tip rotation.Its also hard to understand what all the depressions are. They are atypical for internal valve collapse, which you probably have.PLAN: After a year has passed from surgery, you need the dorsum raised with septal cartilage grafts, the tip undermined and rotated  by trimming the caudal septum anteriorly . The redundant lower edge of the upper lateral cartilages should be trimmed, preserving the mucosa on the interior surface. Spreader grafts for the internal valves are usually not needed when you graft the dorsum. I don't know what is needed for the alar cartilages, but I would check them out.  Now this plan may be modified after an examination or during surgery. I would keep the nose taped for more than a week, changing the tape if necessary, maybe using 2 silk sutures to close the anterior transfixion incision and leaving the silk in for several weeks or more, supporting the tip until the gross edema decreases.