1 Year Post Rhinoplasty. How to communicate my lack of satisfaction with the results to MD using proper terminology?

Question

Greetings all, I had my primary rhinoplasty performed in May 2018 and am a year and 3 months recovered. I am dissatisfied with my results and don't know how to best communicate the details of what is upsetting me with my doctor other than "it's too big" / "it's too long"/ "the tip is droopy." We have discussed a revision but I would like another opinion of what could be improved in detailed medical jargon that I do not possess.

Steven M. Denenberg, MD · Answer

Your nose is very strong in its forward projection from your face. That's called a "projecting" nose. The tip needs to be brought back closer to your face. We call that "de-projecting" the tip.
Your nose is "long," where "length" is measured from where the nose begins, up in front of the eyes, down along the bridge to the tip. So a "long" nose has a droopy tip that sits low. Your nose is very long, and the tip needs to be elevated. 
The good news is that, in expert hands, elevating and de-projecting a tip are two of the more predicatable changes to make in a rhinoplasty, even in a revision. The woman in the short video that I posted with this answer had the tip of her nose elevated substantially in her revision operation.
However, it's not clear that your surgeon can make these changes. Your nose was very projecting and long before surgery, but it appears that those two features were not changed in your operation. You need to read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon, and how to tell whether your first surgeon should be performing your revision. For example, here is an excerpt: "You need to consider whether things didn't turn out great on your first operation because of some unusual circumstance with the surgery or the healing, or whether things went wrong because your doctor was not expert in rhinoplasty in the first place. ... If your surgeon couldn't get you close to your goal the first time because of a lack of skill, he will have no chance at all on the second try, and then you'll be in the tough position of looking for a third operation."
I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Three-quarter views would also be particularly important in morphing your nose. (Side note: in my opinion, morphs should always be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and only the surgeon has that information and judgment.)
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, requiring skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. 
Your nose is also a perfect 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. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Thomas A. Mustoe, MD, FACS · Answer

You have an over projecting tip, and your columella which hung down some before surgery is worse after.   Reducing tip projection is highly predictable as well as reducing columella show, but from the front view may make look your tip look a slightly larger because the soft tissue envelope has to shrink to a smaller framework and so may thicken slightly.

Thomas Trevisani, MD · Answer

In person exam is essential, as well as reading your op-report.Based on your limited photos - it appears that revision Rhinoplasty -preferably  performed through a closed technique- will help you achieve your goals. Keep in mind that Rhinoplasty , especially revision -is one of the most challenging surgeries we perform, therefore it must be performed by an experienced, skilled and talented Rhinoplasty Surgeon.

Jon F. Harrell, DO, FACS · Answer

It really shouldn't be necessary for you to use medical 'jargon' when speaking to your surgeon. You described your concerns quite well in plain english. Basically you are looking to de-project and rotate the tip, better define the tip and smooth out the bridge - all of which are reasonable goals. See another surgeon for a second opinion if you feel your current surgeon doesn't appear to comprehend your concerns.  Best of Luck  Dr Harrell

William Portuese, MD · Answer

The limited photographs demonstrate an overly projecting nose and a significant hanging columella.  A closed rhinoplasty approach can accomplish reduction of the columella, refining the nasal tip and making other adjustments to the nose as necessary. Revision rhinoplasty is more difficult than a primary rhinoplasty, so it's important to choose your surgeon wisely based on extensive experience.

Kailash Narasimhan, MD · Answer

After one year, if you are still dissatisfied with your results than a revision may be considered.  Enlarged tip and septum, and hanging columella (base of nose) can be addressed with cartilage shaping maneuvers.  This would reduce the size of the tip and also reduce the amount of nostrils showing.  While we strive for perfect symmetry in the nose, occasionally there may be minor irregularities in the contour.   Good luck!
Kailash Narasimhan, MD
Board-certified plastic surgeon
Tampa Bay Florida 
Rhinoplasty specialist 
Npstampabay.com

1 Year Post Rhinoplasty. How to communicate my lack of satisfaction with the results to MD using proper terminology?

Answers (6)

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