Tip Raised Too High, Nostrils Are Showing Too Much! Can It Be Fixed? (photo)

Question

I had an open rhinoplasty 3 weeks ago. My doctor removed a hump, narrowed the bridge, and raised the tip. After the cast was removed it looked good to me, but now I really worry that my tip is raised too high, my nostrils are showing too much and overall nose looks small against the rest of my face. Will the tip drop back? If not can this be fixed in the future? I am seriously thinking about revision rhino. Please give me your opinion. Thank you !

Eric M. Joseph, MD · Answer

I read your concerns and reviewed your photos:

	Your photos show your nose up close, but most of your face is missing, so it is difficult to make recommendations with the data you provided. Feel free to re ask your question with full-face photos; before photos would be helpful too.

	In general, your nasal tip may lower a bit over the ensuing months as you continue to heal. Revision rhinoplasty to derotate your tip would be a difficult, and based on the photos you provided, I doubt this would be necessary.

	Good luck with the rest of your healing.

	Hope this helps.

	Dr. Joseph

Barry L. Eppley, MD, DMD · Answer

It is way too early to judge your final tip position and shape. It is very common for a tip to look too high in the first few weeks after rhinoplasty only to see it settle out and drop down a little over the next few months. Wait until at least three months after surgery before making a critical analysis.

Edward E. Dickerson, IV, MD · Answer

When the bandages are first removed your nose will look as if it is swollen and turned up too much. The post-op swelling in your nose and upper lip that you are experiencing is responsible for these results. You may also notice that for a week your upper lip may be stiff due to the work done in that area, this should go away in a few weeks. Allow up to a year for the swelling to completely go down and for your nose to take shape. A majority of the swelling should go down within two weeks of having your bandages removed. You may also need some time to get used to your new look!

	"Dr.D"

Michael R. Menachof, MD · Answer

As hard as it is to do right now, you just need to be patient. Your nose will continue to change over the next 6- 8 months at a minimum. The key to doing a great rhinoplasty is not getting the nose to look the way that you want on the table, at 1 week, or at 3 weeks, but getting it to look the way you want at 8 months. Trust the fact that it will change, trust your surgeons abilities (after all, isn't that why you chose him or her), and give it some time. It will change and will almost certainly get better. Good luck.

Leonard T. Yu, MD · Answer

You need to be patient. Your nasal shape will definately change over the next 9-12 months. The photos that we show people are taken 1yr after surgery for rhinoplasty as things will change from how it looks now.

Richard J. Brown, MD · Answer

You express many of the concerns that almost every Rhinoplasty patient goes through, including myself having had a Rhinoplasty in the past. You are way too early in the post operative period to worry about most of these issues. Swelling will exist for at least 12 months and most of it does resolve in 3-6 months such that you can begin to notice the result. Since none of us were present for you procedure it is hard to comment on what surgical maneuvers will or will not change with time. I can tell you that taking down the bump gives the illusion that the tip was rotated up because now you have small break just in front of the tip, called a supratip break, that makes it look like the tip was turned upward. Many patients call it the ski slope appearance. Give this several months before you worry about even considering any type of revision. I will almost never revise even one of my own noses for 12 months because it takes that long for scars to soften and for the tissue planes to become easier to dissect once again. The answer to your last question is yes, you can have it fixed, however you will never have your original shape back. Once cartilages have been trimmed and removed it is hard to return them to their original form, but we can get close at times. I think you will find that 1. things will settle with time as swelling resolves, and 2. you will get used to your new nose and probably love it. It took me 6-8 months before I realized I loved my results, and I too freaked out in the first few weeks. It will all be good in the end.

M. Vincent Makhlouf, MD, FACS · Answer

From these pictures taken only 3 weeks after surgery, my impression is that the nose is fine. tissue relaxes over time and I think your nose will be fine. It is not the right thing to be talking about a revision at this stage of the game. Be patient. If in the future you have more "columellar show" than you like, it can be easily corrected in the office under local anesthesia it is a simple and easy fix. For now relax.

Francis R. Palmer, III, MD (retired) · Answer

Yes, there is a localized procedure that I have performed that will tuck the Columella up in such a manner that the nostrils don't show as much on front and profile. This does not require a complete Rhinoplasty. Hope this helps.

Michael Elam, MD (retired) · Answer

Dear Ellen,

	It is to early to determine your overall result however I do see your concerns in the provided photographs. Your nose does look aesthetically pleasing in your photograph taken when the splint was removed however your tip appears over rotated in the three week post operative photograph. You will need to allow a full year to see your final result before you consider revision rhinoplasty. If you find your results unsatisfactory at that time then a revision rhinoplasty may correct some of your complaints. At this time I would discuss your concerns with your surgeon and see him/her for frequent follow up appointments. Time is on your side and try and have some patience before rushing into any major concerns. Best regards, Michael V. Elam, M.D.

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