Revision Rhinoplasty: Not to be considered lightly or too soon
My advice to patients is simple: Rhinoplasty result takes a year to fully develop and consideration is usually not given to a revision for 12 months. Rhinoplasty is a complicated procedure and revision Rhinoplasty more complicated still. It is best to undergo surgery when the conditions are optimal for the best result when inflammation has subsided.
Revision rhinoplasty Important Considerations
Unfortunately you are in good company. Most rhinoplasty patients out
there are very unhappy with their results in 1-2 years. The explanation
for this is very simple: Most surgeons performing rhinoplasty do not
have advanced training or experience, they perform the rhinoplasty of 50
years ago. Decades ago thought process of rhinoplasty was to remove
cartilage to refine the shape of the nose and perform it through an open
approach. An open approach makes it easy for neophyte surgeons to
access visualize and manipulate the structures but also unnecessarily
destroys two arteries and veins that are important for nasal
vascularity. The open approach thus ensures that patients have 1-2
years of risidual swelling which hides the final result. Most
rhinoplasties out there I consider cartilage robbing thus when the
swlling resolves there is inadequate structure to provide aesthetic
appearance and fight the cicatriacial forces or the continued scarring
that results from the lowered oxygen tension and fibrosis of tissues.
One additional problem it that most rhinoplasty surgeons out there
inadvertently break the connection between the bony nose and the
cartilagenous nose. this can cause irregular narrowing and what we
calll "the inverted V deformity" which means the outline of the nasal
bone becomes visible through the skin particularly in flash photography
under certain lighting conditions.
In my opinion, an expert
level rhinoplasty is always performed in a closed technique and ALWAYS
involves grafting to add to the structural integrity of the nose. The
act of opening the nose even under the closed technique causes healing
and some contraction, thus for a long term beautiful result the nose
must be left more structurally sound than it was found. This is missed
upon most rhinoplasty surgeons.
In secondary cases such as
yours it is even more crucial that sound grafting techniques are used.
Definitely do not consider any rhinoplasty procedure that does not
include grafting preferably by an experienced Plastic and reconstructive
training with ddition fellowship level craniofacial and aesthetic
training. Of course this is my bias because it is my training but I
think this level of training is very necessary for success in secondary
and tertiary rhinoplasty because there is delicate nuance involved and
every patient requires different maneuvers. I hope this helps!
All the best,
Rian A. Maercks M.D.
First of all, I would absolutely concur with the other surgeons who have previously answered your question. You should wait until around 12 months after your rhinoplasty before considering revision rhinoplasty. As things settle out, you may find that you are no longer bothered by the appearance of your nose...
Obviously, I would need to examine your nose, both inside and out, to give you an accurate diagnosis. However, based purely on your photo, my suspicions are that you may be headed in the direction of having a pinched tip. Additional photos would certainly be helpful. This pinched tip may be a result of sutures which bind the tip cartilages, or "domes", together, changing the natural contour of these cartilages. In these cases, it's a matter of removing these sutures and reshaping your tip cartilages in a more normal, aesthetically pleasing way. I would do this through an open rhinoplasty approach.
This type of nasal shape can also be due to your lower lateral cartilages being weaker than they need to be. This problem can be corrected with lateral crural strut grafts, which are cartilage grafts placed under your tip cartilages to support and strengthen them.
You should bring up your concerns with your surgeon but be patient before proceeding with revision surgery. Good luck!
Three months after surgery is too early a time frame to come to any conclusions about the tip. It really takes a full year for the tip to assume its final shape and form
Revision Rhinoplasty - Wait At Least One Year
I am sorry to hear that you are not fully satisfied with the results of your procedure. It is difficult to say for sure what you should do without seeing your results in person through an examination. Swelling can take up to a year to resolve so you should wait at least 12 months for final results to show. After that time you will be able to better determine whether or not a revision procedure is necessary. In many circumstances your results will continue to improve and you will become personally adjusted to your new look.
A pinch tip or supra-tip could be the consequence of per-existing pinch, suture techniques or excessive reduction of the nose cartilages specially on a patients who have convex tip cartilages that are oriented upwards. The solution is surgical correction of the problem for a permanent improvement after about a year following the initial surgery. Unfortunately, waiting is not going to correct the pinched tip or supra-tip pinch. Actually, it may get worse over time as the swelling subsides. The reason for waiting for about year is that with the healing other imperfections may develop and an early surgery my necessitate a second revision because of the other problems that cannot be seen at this time. If the pinch deformity is troubling you enough, it can be corrected temporarily with the fillers until you are ready for the final operation. You may consult your surgeon about the use of fillers to allow the final correction when the time is right.
Do not Rush into Revision Rhinoplasty prematurely
I know you might be disappointed, but you would be served best if you wait for one year before doing a revision rhinoplasty.
Three months is very early as your nose has a great deal of swelling and will continue to improve over the next 12 months.
Please try to avoid using fillers in the nose. It is not FDA approved and cause permanent discoloration and skin changes of your nasal skin.
Timing of Revision Rhinoplasty
As other plastic surgeons have already stated, one must wait an appropriate length of time even before considering revision rhinoplasty procedure. Three months is too early. The nose will continue change and gradually improves with time. Lastly, injectable fillers should not be placed in the tip of the nose due to significant risk of skin and cartilage damage. Speak with your rhinoplasty plastic surgeon for any concerns you may have. Best of luck.
Revision rhinoplasty timing for decision
3 months is much too early to make any decisions regarding revision. Furthermore, determination of the cause of the aesthetic issue is more complicated than meets the eye--it is really all about balance. Balance in contour from the top of the nose to the tip. Imbalance in width can give the appearance of unusual/untoward narrowing or widening. Also, the contour of the nose is difficult to determine without proper standardized photography.
Communicate your concerns with your surgeon, who should help guide you through this process.
Hope this helps.
Wait Before You Consider Revision Rhinoplasty
First and foremost, it is too early for you know whether or not you should consider revision rhinoplasty. The nose will undergo significant changes during the first several months after rhinoplasty. As the swelling goes down, you may be more pleased with your results.
The general consensus among rhinoplasty specialists is that a patient wait for 12 months before proceeding with any revision. The reason for this is that it can take 12 months (or longer) for the majority of the post-operative swelling to subside and for scar tissue to mature.
Residual deformities following a rhinoplasty can vary in severity. For minor deformities or depressions, a "Non-Surgical Nose Job" using injectible filler substances can help camouflage the problem.
Occasionally, the problems are more pronounced and require additional surgery. Revision (secondary) rhinoplasty is more difficult than primary rhinoplasty and requires more expertise. It is therefore important to select a highly qualified surgeon who is experienced in secondary rhinoplasty when the revision of a previous nose job is required.
The cost of revision rhinoplasty can vary significantly depending on what needs to be done to correct the problems with the nose. Sometimes a revision is a minor undertaking and can be accomplished in the office with local anesthetic. Most surgeons will correct imperfections that weren't adequatelty addressed or arose from the original surgery for their own patients at no additional charge. This is something that varies from practice to practice.
If you are seeking a complete "re-do" by another surgeon, the cost can range from $6,000 to $25,000. With major structural deformities, cartilage grafts are required to rebuild the nasal framework. Septal cartilage, while the preferred source of cartilage grafts, has usually been depleted during the first operation. Revision Rhinoplasty Surgeons then have to "borrow" cartilage from another part of the body - such as the ear or rib. This increases the operative time and cost.
Speak with your surgeon about your concerns regarding your tip deformity. If you do not feel comfortable with the surgeon who performed your surgery, you should seek the advice of a rhinoplasty specialist who has expertise in secondary (revision) rhinoplasty.