Seeking revision - Overprojected tip Pinocchio nose, will I get this desired outcome? (photos)

Question

I had primary open rhinoplasty in Dec.2015. The goal was to remove bump, reduce overall projection, preserve front. The bump was successfully removed, but the tip projection wasn’t changed, my nose is curved inward with overprojected tip, out of balance. A tip reduction could improve my nose appearance. I ptotoshoped my recent photos to show how I would like to see my nose to be de-projected (tip only). Any advice on surgical techniques to achieve the desired outcome will be appreciated

Alejandro Nogueira, MD · Answer

I might be likely wrong, of course, but as per how your nostrils look fron underneath, so fake and unnaturally stretched forwardly, and how your tip points and is projected, I'd bet your surgeon applied a strut graft with random criterion in a non-indicated case, this means unnecessarily... in a case of no special loss of tip support / projection... leading to such pinoccio's nose deformity... and if not a graft a very aggressive plication, but my bet is a columellar strut graft with poor judgement, just because... It is epidemic, I had many revision cases like you and here on RS you will find hundreds of such cases; when a surgeon has no idea how to impress patients and colleagues he applies struts, are they better called "strutters" ;) ?
My second bet: you were a case for just closed endonasal approach, the reason to make open rhinoplasty was just... the strut graft... due to a wrongly diagnosed poorly supported tip (that is why struts are applied at the medial cruras).
When applying strut grafts without criterion you create a very specific and typical look, like yours. Strut grafts are an excellent tool in rhinoplasties... of ethnic, congenital and revisional features, not in you.
Do seek the advice of a revision rhinoplasty specialist; in his hands deprojection your tip is really easy, just removing the strut or deprojecting it to achieve good balance with the dorsum; I recomend also not that pinched tip you have now.
Other enhancement you may be case for (if you wished so): correct the still high dorsum, your facial balance needs a slightly more lowered (not sunken!) dorsum, and repeat the osteotomies, they are visible at the nasal walls because they were placed too high.
If you wish better grounded opinion please do post or send privately well lit, focused and standard images: frontal, both lateral and both oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

Steven M. Denenberg, MD · Answer

In the revision operations I perform, reducing persistent projection is one of the most common changes to make.
You should understand that changing the projection in a revision, however, requires advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon, and how to tell whether your primary surgeon should be performing your revision. You should only have surgery if you are able to make yourself very confident in your surgeon's skills.
I usually make computer morphs when I'm answering a RealSelf question, to show the changes that are possible for your nose with a rhinoplasty. For example see this page:FacialSurgery.com/RealSelf/RealSelf_Morphs.html
But unfortunately the photos you submitted aren't large enough for making good morphs. At the *very* bottom of the Web reference page is a link to instructions on taking photos that are more comprehensive and useful for online consultations like this, in case you'd like a more complete evaluation.

William Portuese, MD · Answer

A thorough internal and external examination of the nose is required to make a determination about what may be required, since a revision Rhinoplasty is much more difficult than a primary rhinoplasty. Cartilage grafting techniques may also be required, so it it's important to know how much cartilage is left on the inside of the nose after the primary rhinoplasty. A full and complete revision rhinoplasty will be required to make sure all the components of the nose are in balance with each other.

Seeking revision - Overprojected tip Pinocchio nose, will I get this desired outcome? (photos)

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Seeking revision - Overprojected tip Pinocchio nose, will I get this desired outcome? (photos)

Answers (3)

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Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.