Tip + Revision Rhinoplasty. Why does it take so long for the tip to contour after a revision?

After rhinoplasty, tip shape is typically the last thing to settle before seeing the final result; this can take 12 months or longer. After revision rhinoplasty, this process can take even longer due to additional scar tissue and altered blood and lymphatic flow in the nose as it heals. At 11 months following revision rhinoplasty, you will still notice improvement in the size of your nose. With regards to your concerns about the size of your nasal tip, this area tends to be most sensitive and effected by swelling. Recovery after rhinoplasty will vary based on the person, characteristics of the nasal tissues and what was done during surgery. It can take somewhere in and around 12-18 months to see the final results. For revision rhinoplasty, it can take longer for all of the swelling to subside. The areas with thicker skin in the nose such as the tip, alar rims and radix will require longer to settle. Also there appears to be a linear decrease in swelling for the first several months followed by a period where the swelling fluctuates (sometimes little or no swelling and other times more swelling) before the nose settles.

The question you pose is good and I hear it often from patients that have undergone rhinoplasty, both primary and revision. The problem is the answer is so variable for each patient that it is not possible to give one that will cover all cases.

It everything was done properly during your surgery there are many factors that can cause a tip to look full:

In general the thicker (and more scarred) the skin is the longer it will take for the swelling to go down and tip definition to be seen.

If a lot of reduction in size has been done (making the nose a lot smaller) it will take longer for skin to contract around a new smaller tip. My general philosophy is to keep the tip fairly defined and projected and to avoid too much reduction-this helps it look refined sooner and reduces potential problems down the road.

Time of the day that you look at your nose is a factor-usually first thing in the morning your nose will look swollen and tend to look smaller later in the day as some of the swelling goes down.

There are factors that occurred during your surgery that may make your tip look full:

It is possible that there was a buildup of scar tissue around your tip that was not addressed or that there was not enough sculpting of the tip cartilages. There may have been too much reduction in tip support. All of these factors play in to the final appearance and refinement of the nasal tip.

Without seeing before and after photos it is all just speculation. I would bring your concerns to your surgeon and have a frank discussion.

Good luck.

 

Your concerns are not uncommon among those undergoing revision rhinoplasty. Each time the nose is operated on, more scar tissue forms. It is this scar tissue and contracture which take time to reorganize. It is an extremely difficult operation because it is very difficult to determine how the nose is going to change when performing techniques required in revision cases (such as cartilaginous grafting). Many times a surgeon must use strong cartilage such as that obtained from a rib to counteract these forces. The disadvantage to rib cartilage, however, is that the nose no longer is pliable and deformable like it used to be. All these factors cause the nose to remain a little more stiff and swollen for a longer period of time. I tell all my revision patients that their nose at 1 year out is still changing. Visiting a surgeon who listens to you and is well versed in revision cases is a necessity. Good Luch to you and be reassured that the nose will continue to soften up with time.

The fact that you are starting to see even slight changes in your tip definition is promising and should give you hope. As a specialist in revision rhinoplasty, I have observed that it can take up to a full year for the final result of the rhinoplasty to manifest, especially a revision rhinoplasty when more advanced techniques are often used. Much as a foot swells when an ankle is injured due to gravity, the tip of the nose always has the most prolonged swelling for this same reason. Since you are still seeing changes and improvement in the tip at this point, this in and of itself should help you to keep a positive attitude. Continue to follow up with your plastic surgeon and discuss your concerns openly.

Without seeing your before and knowing what was done it's hard to be precise. However I have done many revisions which involved releasing severe scar, reconstructing cartilage and supporting soft tissue to avoid future scar. In a number of these patients I know and tell them to expect an 18-24 month "project" to see final results. Be patient and talk to your surgeon about his/her expectations for you.

 I have performed Rhinoplasty and Revision Rhinoplasty for 25 years and the nose is unique in that each Rhinoplasty creates tissue injury and changes that increase with subsequent Rhinoplasty Surgeries.  This includes lack of lymphatic drainage leading to prolonged nasal swelling.  The nose does not allow swelling to remain unchanged for longer periods of time and eventually replaces it with subcutaneous scar tissue formation.  Both of these processes contribute to the thickness and hardness of the tip.  

 This is why I teach all my Rhinoplasty and Revision Rhinoplasty patients how to perform daily manual lymphatic drainage of the nose.  Reducing post Rhinoplasty swelling is one of the most effective ways of preventing internal scar tissue formation in the nose.  Hope this helps.