Had a septoplasty/rhinoplasty about 6 years ago. I think the tip needs refinement? (Photos)

Had a septoplasty/rhinoplasty about 6 years ago. I think the tip needs refinement. I'd like it to not point down, especially worse when I smile. I know I have to see a good surgeon for a consultation and have one booked for next week actually. But I was curious what other doctors opinions would be on how my nose could be improved. Does it appear like a candidate for just a tip revision? Fortunately I still have plenty of nose to work with, as first surgeon didn't shorten enough.

Doctor Answers 10

Yes your nose could be shortened. And also brought back closer to your face. See the morph I made.

Click on the "Web reference" link, just below my response, or go here:

FacialSurgery.com/RealSelf/RealSelf_worldsick.html

I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.

I elevated the tip of your nose, and then I brought the entire nose back closer to your face, so it doesn't protrude forward as much.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.


Omaha Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

Tip revision rhiniplasty

Though your photos are only providing one and a half angles to evaluate, it appears that your nose may be over projected, has a tendency to droop when smiling, and the tip could use a bit more refinement.  After six years, you are probably an excellent candidate to have all of these issues addressed and I suspect that in the hands of an experienced rhinoplasty surgeon, you will get a rhinoplasty result that you will be extremely happy with.  Make certain that you are clear when you convey your wishes to your surgeon during your consultation.

Philip S. Schoenfeld, MD, FACS
Chevy Chase Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Revision rhinoplasty for further nose improvement.

Judging from your photos, it appears your instinct is correct. Further tip work to build upon what was done during your prior rhinoplasty would likely be very beneficial. A shorter nose with improved symmetry that does not droop with talking or smiling would be quite beneficial, providing the results looked natural. Make sure you get the opportunity to see your pictures "imaged" before you commit with a surgeon so that you may preview and endorse the surgical goal. Good luck with your consultation! -Randolph Capone, MD, FACS

Randolph Capone, MD, FACS
Baltimore Facial Plastic Surgeon
4.9 out of 5 stars 45 reviews

Tip refinement after previous Rhinoplasty

A full set of photographs, especially a true lateral view would be very helpful but based on the photos you submitted, it does look like you have an extremely droopy tip that would benefit from a revision Rhinoplasty. Whenever the tip is rotated, it may be necessary to make adjustments to other parts of the nose especially the bridge.  As you already have, a consultation with an experienced revision Rhinoplasty surgeon would be advisable to look at your options.

Devinder S. Mangat, MD, FACS
Cincinnati Facial Plastic Surgeon
3.8 out of 5 stars 25 reviews

Rhinoplasty

You would have to be seen in person to determine what your concerns are and what might be necessary to achieve them.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Had septoplasty/rhinoplasty about six years ago. I think the tip needs refinement?

A revision rhinoplasty is more difficult than a primary rhinoplasty due to the fact that there have been previous alterations in the nasal anatomy and there's going to be scar tissue present. Choose your second surgeon very wisely based on extensive experience producing natural results consistently. A full rhinoplasty is usually required, not just a tip-plasty. In addition, a full set of  facial photographs are required because the nose is a three-dimensional structure. The tip of the nose can be lifted and refined with suture techniques and conservative cartilage removal, if necessary. To prevent the tip of the nose from drooping when smiling requires releasing of the depressor septi ligament. For more information and many before and after examples of rhinoplasty, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Revision Tip Surgery

It is hard to judge from the limited photographs that you have posted but it appears that your nose is too long, your tip is asymmetric and plunges with the smile. You can post or e-mail your true front, profile and head tilted back views which would give us more information to advise you meaningfully.

Good Luck

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.8 out of 5 stars 21 reviews

Tip Revision?

Hi and thanks for your photos and question.  Yes, I do think that you would benefit from a revision rhinoplasty.  To fully evaluate your nose, I would need good quality photos from the front, sides, base of the nose (looking up your nostrils) and diagonal views from each side.  However, I do think that I see what is called tip bossa formation where the tip cartilages make knuckles that pull apart and  distort the tip.  I would be happy to see you for a consultation with computer imaging to show you what I would do to revise your nose.  Also, if you look at the video that I am attaching, there is an example of a female patient with severe bossa formation that you will see.  Good luck. Dr. Pontell

Jonathan Pontell, MD, FACS
Philadelphia Facial Plastic Surgeon
4.8 out of 5 stars 101 reviews

Good candidate of a nose revision

from  what I can see, you are a good candidate for revision rhinoplasty. Sometimes after some years the nose can loose projection and appear to be droopy.  You also have a bifid tip. I would ask your surgeon if she/he is planning to do your surgery with an open rhinoplasty technique as it appears as that would be the best technique.

Carlos Wolf, MD
Miami Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

For sure..

It appears that you have had a typical closed rhinoplasty where your dorsum was slightly over-resected and your tip left essentially untouched....as you accurately describe, your dorsum is somewhat concave but your overall nasal length unchanged

Revision rhinoplasties are best done in a 'complete' manner....this should not frighten you into thinking that means 'complicated'....refining your tip can most certainly be accomplished, but must not be done in a vacuum....you would likely benefit from a bit of shortening and restoring dorsal lines to undo the 'flattening' as well

You are obviously attractive and as such your nose is not as distracting as it otherwise might be...so take your time choosing an experienced/proven rhinoplasty expert and acquire an understanding of the entire process from evaluation to execution

By visiting a few board certified plastic surgeons who's practices are focused on rhinoplasty and committed to revisions and tough cases, you will be most likely to make a good choice and become happy/satisfied at the end of your journey

Good luck...

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.