Why do noses look fatter/wider AFTER rhinoplasty?

Question

I'm scheduled for a rhinoplasty this month. I watched plenty of Youtube rhinoplasty vlogs and pictures, many have "bigger" or "lumpy" looking noses after. Almost like a piggy-ish look at the tip. I KNOW swelling takes time, but even after a year some of them have (yes less definition) but it looks fatter at the nostril area. Why is this? How is this when they graft OFF the nose and trying to REDUCE the size. It's freaking me out. I want a SMALLER nose and want to remove some bumps on the tip.

Alejandro Nogueira, MD · Answer

There are some typical and sadly very common technical shortfalls and errors in rhinoplasties; including but not limited to the ones you pointed out, let me explain reasons why:-broad dorsums: aka "open roof deformity", due to absent or incompetent nasal bones osteotomies (normally associated with inverted V deformity)-piggy noses: there is a "taboo" maneuver which I personally still don't reach to understand why so many of my colleagues keep on practicing, it is the caudal septum resection / trimming... it leads to a absolutely upturned and fake look, piggish; additionally overresection of alar cartilages or upper lateral cartilages may be contributing factors-being true some noses need augmentation (shor or small tips, short septums, short noses, low dorsums, low radix, etc.), still grafting may be required not to augment but to reshape and redefine the shape and location, for example, of a tip; this is why in some reduction rhinoplasties a graft at the tip has to be used-massive deprojection of tips lead to an horizontal expansion of the nostrils, therefore they apparently "grow" which actually is a broadening; if this is unacceptable or beyond proportions it is easy to trim them our and reduceDon't freak out, the phenomenons you have detected have very well known (for some doctors...) physical explanations, can be treated, prevented or customized.It is if paramount importance you end in the hands of a really good and experienced rhinoplasty surgeon.

Steven M. Denenberg, MD · Answer

If you did, and you like them, and his noses don't look fatter after surgery, and he thinks you're a good candidate for the operation, then don't let other things you see on the Internet freak you out. Having a bigger nose after surgery certainly is *not* the goal. 
I usually make computer morphs when I'm answering a RealSelf question, to show the changes that are possible for your nose with a rhinoplasty. For example see this page:FacialSurgery.com/RealSelf/RealSelf_Morphs.html
But of course you didn't post any photos. Is there something about your particular nose that makes you fear it getting wider after surgery? See the "Web reference" link, just below my post. At the *very* bottom of the Web reference page is a link to instructions on taking photos that are useful for online consultations like this, in case you'd like a more complete evaluation.

Deepak Raj Dugar, MD · Answer

You should be doing scarless closed rhinoplasty for the most finesse surgical option without extensive swelling. The cuts at the base of the nose cause dreaded permanent scars and swelling that lingers.

Seek a surgeon whose 100% surgical practice is dedicated to scarless closed rhinoplasty.

Seek a surgeon whose 100% surgical practice is dedicated to scarless closed rhinoplasty.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  Often this appearance is due to swelling.  But you are correct in that the swelling should be gone by one year.  My best advice is to specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system.  If you like all of your surgeon's before and after pictures, then try not to worry so much and you will also likely have a good outcome.Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Manish H. Shah, MD, FACS · Answer

Hello,Thanks for your question.Noses can look wider after surgery for several reasons:1. increased width of the nasal bones after the hump is removed2. excess swelling in the nasal tip3. nasal tip scar that thickens the tip4. thick nasal tip skin that doesn't shrink well after rhinoplasty5. vascular congestion of the nasal tip skinThe blood supply to the nasal tip skin is very tiny. When it gets damaged, it can have problems rebuilding properly. This can cause a backup of swelling (edema) to the tip. This edema can be permanent in some cases. Ethnic patients with thick, oily tip skin have a difficult time getting smaller tips. Methods to improve this might include nasal tip steroid injections, nasal tip cartilage grafts, and use of retinols/Accutane to help the skin thin out more.Make sure you address these questions to your surgeon to get their take on the subject.Good luck,Dr. Shah

Why do noses look fatter/wider AFTER rhinoplasty?

Answers (5)