Nose Tip Over Corrected, Will There Be Enough Skin On the Tip to Fix This?

4 months ago I had open-rhinoplasty tip augmentation work, and think the tip is still very overly rotated, with a very miss piggy look. I am pretty sure that I'm going to need revision. I had heard though that skin shrinkage occurs, and that this limits the amount of de-rotation possible. Is it too soon to seek revision sooner rather than later to prevent this skin limitation? Thanks

Doctor Answers 4

De rotate a tip

I am sorry that you are unhappy with your nasal tip.  You will need to wait about a year for the swelling and the tissues to soften so that the revision can be performed.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Nose Tip Over Corrected, Will There Be Enough Skin On the Tip to Fix This?

No, the skin will not shrink to the extent that the tip could not be lengthened, IMHO.  You should be seen for a few consultations with well experienced Revision Rhinoplasty Surgeons.  Sometimes, it's best to tuck the columella, making the tip appear to be rotated downward through a closed Rhinoplasty.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Revision rhinoplasty for the overdone nose.

There is usually enough skin, but you need to wait 6-9 months for the skin to loosen. See an experienced revision rhinoplasty surgeon for the best results.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

IS there enough skin?

Several things need to be answered.   Most revision or corrective rhinoplasty if it is to occur should occur no sooner than 6 months after the original procedure.  Some surgeons recommend up to one year to wait for corrective or revision surgery.  As for the quantity of skin.  The skin tends to redrape over the osteocartilaginous structures of the nose.   It is unfortunate that we are unable to predict, quantity, or enlarge or decrease the amount of skin or soft tissue over the nasal framework.   Natural healing tends to allow skin shrinkage over the usually decreased size of the bony/cartilaginous frame.  Enlarging the amount of skin is not attempted as well.

As for the amount of rotation, de-rotation, much of this is determined by the surgical maneuvers performed during the surgery,  The amount of tautness of the tissue to the cartilage frame is often an indication of the amount of scarring that is occuring post-operatively.  Open rhinoplasties tend to take longer to heal than closed rhinoplasty----there is more cutting and more dissection and hence more surgery performed.  To allow as little scar formation as possible, cartilaginous grafts and sutures tend to be used more aggressively in open rhinoplasties than in closed rhinoplasties to create more rigid support framework to combat the natural occuring phenomenon of scar contracture.  The more sturdy the structure(the new bony/cartilaginous frame of the nose), the less apt that "vacuum shrinkage" of the skin can occur around the cartilaginous frame.  

So, wait at least 6 months before doing anything surgical.  Speak with your surgeon about what you want and whether it is a realistic venture or not.  As far as skin shrinkage, the skin will stretch also, but up to a point.

Jonathan Berman, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 14 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.