I had open Rhinoplasty 3 months ago. I think I have supra alar pinched tip, although the tip itself is not pinched. This is my picture, can you please confirm this? Do you think the tip itself is still swollen so it makes it look even worse?
Another thing, what is the cost and recovery process for a revision for this issue? Is it like the open rhinoplasty? Can I use fillers instead or is the pinching too deep? Sorry for all the questions but I am confused. Thanks!
Answer: 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.
Helpful 8 people found this helpful
Answer: 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.
Helpful 8 people found this helpful
Answer: 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.
Helpful 1 person found this helpful
Answer: 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.
Helpful 1 person found this helpful
June 30, 2019
Answer: Pinch Tip 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.
Helpful 2 people found this helpful
June 30, 2019
Answer: Pinch Tip 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.
Helpful 2 people found this helpful
October 20, 2013
Answer: Some Aspects of a Nose Cannot Be Changed It's VERY important to realize that there are some features of a nose that cannot be changed -- and therefore some people will never get the ideal nose that they dream about. In other words, you can't make any nose out of any nose. Two of these unalterable features are the overall length of the nose from the brows down to where the columella attaches to the upper lip. Another is the vertical height of the lateral ala (the part that attaches to the face), the shape of which is made up of and determined by fibro-fatty tissue, not just cartilage and skin (like the tip and medial ala). In your case, both of these anatomical features are proportionately too long, and therefore you will never have ideal nasal features and proportions. My concern is that you are seeing things that you still don't like about your nose, but not really knowing what they are exactly. I suspect that what you are "sensing" are the disproportions I just described.The message is this: There are some things about our bodies that cannot be made ideal through surgery -- and we all just have to try to learn to live with those things and love them as much as we can. Beware the Michael Jackson syndrome -- where you keep trying to chase an ideal that cannot be achieved -- and end up with something worse than what you started with.
Helpful
October 20, 2013
Answer: Some Aspects of a Nose Cannot Be Changed It's VERY important to realize that there are some features of a nose that cannot be changed -- and therefore some people will never get the ideal nose that they dream about. In other words, you can't make any nose out of any nose. Two of these unalterable features are the overall length of the nose from the brows down to where the columella attaches to the upper lip. Another is the vertical height of the lateral ala (the part that attaches to the face), the shape of which is made up of and determined by fibro-fatty tissue, not just cartilage and skin (like the tip and medial ala). In your case, both of these anatomical features are proportionately too long, and therefore you will never have ideal nasal features and proportions. My concern is that you are seeing things that you still don't like about your nose, but not really knowing what they are exactly. I suspect that what you are "sensing" are the disproportions I just described.The message is this: There are some things about our bodies that cannot be made ideal through surgery -- and we all just have to try to learn to live with those things and love them as much as we can. Beware the Michael Jackson syndrome -- where you keep trying to chase an ideal that cannot be achieved -- and end up with something worse than what you started with.
Helpful
February 19, 2016
Answer: 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.
Helpful 3 people found this helpful
February 19, 2016
Answer: 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.
Helpful 3 people found this helpful