Do I Need Revision Rhinoplasty for Supra Alar Pinched Tip?

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!

Doctor Answers 31

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.


Miami Physician
4.9 out of 5 stars 72 reviews

Last contacted 1 day ago

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.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 86 reviews

Last contacted 2 days ago

Pinched nasal tip

Dear Samra,

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!

Kind regards,

Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 44 reviews

Last contacted 1 hour ago

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Revision

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

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
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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. 

Sam Rizk, MD
New York Facial Plastic Surgeon
4.6 out of 5 stars 70 reviews

Last contacted 18 days ago

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.

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

Last contacted 8 days ago

Wait for final results before Revision Rhinoplasty

Dear Samra, It is to early in the post operative phase to make a determination on your "pinched tip" complaint. Swelling persists in the tip for several months and up to a year following surgery. I would wait a full year and see how this resolves and then make a determination. Revision Rhinoplasty surgery costs vary from area to area and patient to patient. Without having the ability to do a physical examination and determine exactly what may need to be done is impossible to quote a fee. If you feel comfortable with your primary Rhinoplasty Surgeon then I would assume that he/she would do the revision for a nominal fee, this depends on your pre-surgical agreement. Have patience I know it is difficult during this faze however your problems may resolve themselves. Best regards!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 210 reviews

Last contacted 3 hours ago

Do not Rush into Revision Rhinoplasty prematurely

Hi Smara,

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.

Good Luck

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 190 reviews

Last contacted 2 hours ago

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.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 83 reviews

Last contacted 9 hours ago

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.

Sam Most, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 62 reviews

Last contacted 2 hours ago

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.