Twisted and Buckled Nose Tip

Hi. I had a rhinoplasty 2.5 years ago, the tip was fine for the first year or so. Ever since then the tip has sort of twisted and buckled. Is there any possible reason for this? and can anything be done to get the tip lookin normal again? Thanks

Doctor Answers 8

Twisted and Buckled Nasal Tip

As other surgeons have sail the tip distortion is probably secondary to scar contraction. Your present appearance can be improved by a good revision rhinoplasty surgeon. This will probably involve placement of cartilage grafts to restore a desirable tip contour.

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Twisted nasal tip

At two and a half years out from rhinoplasty a possible explanation for the tip twisting is probably the result of scar tissue. You may want to consider s revision.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Twisted tip after rhinoplasty.

This is caused by scar tissue contracting and/or surgery bot providing enough stabilization. This can be revised  and made straight with revision surgery done by an experienced revision rhinoplasty surgeon.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Nose became distorted over time

In many instances the forces exerted by the healing process cannot be predicted and can produce distortion of an initially satisfying result. Surgical revision would require reinforcing the weakened structures to prevent future distortion.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

The nose can continue to change for years following rhinoplasty

Most Facial Plastic & Reconstructive Surgeons consider rhinoplasty to be the most difficult procedure that we perform. It is initially challenging to perform well with the additional risk of changes that occur during the healing process that can take years to be revealed. At 1 year or later following surgery you are a candidate for revision tip rhinoplasty to improve the appearance and symmetry of your nasal tip. Another option would be injecting filler but this is a temporary fix, has the risk of soft tissue loss (uncommon) and will not do anything to improve your nasal breathing (if that's currently an issue). I would recommend returning to your surgeon for further discussion.


Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Can anything be done about delayed twisting and buckling of the tip after rhinoplasty?

Though not a typical occurence, the nasal tip cartilages can buckling or twist after nasal surgery due to scar contracture forces. Here are some points to consider:

  • Patients with weak tip cartilages (some people have more firm nasal tip cartilage than others) have a higher chance of tip buckling. This effect can be amplified in patients with thin skin since any irregularities in the underlying cartilages is more easily seen.
  • Some rhinoplasty surgeons (not necessariy in your case, of course) will resect more cartilage than is ideal which can lead to destabilization.
  • Depending on what was done during your surgery and your current exam findings you may be a candidate for a revision rhinoplasty procedure. My own preference (with initial and revision surgery) is to use a structure-based rhinoplasty approach. This involves maintaining/increasing the strength and stability of the nasal framework which allows the nose to withstand the natural scarring forces. In my experience, this has allowed for excellent correction of tip cartilage irregularities.
  • Having an injectible filer placed in the nasal tip to camouflage is a possibility. There are significant issues with regard to filler placement to avoid permanently injuring the nose. Importantly, most fillers are not permanent which would require you to get repeated treatments for the rest of your life.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Considering revision rhinoplasty 2.5 years after surgery? You have options!

Well, it's definitely a drag that your nose has started to show some changes including buckling and twisting.  This may occur as scar tissue develops and structures shift under the skin. 

Fortunately, you have several options!

  1. Revision Rhinoplasty surgery which may involve using some of your own cartilage to reconstruct your nose.
  2. Non-surgical revision rhinoplasty using dermafillers to correct some of the concavities and asymmetries that have occurred.

I recommend consulting with a surgeon or two that does both to give you both options.  Good luck and hang in there!

For examples of Revision Rhinoplasty cases  I have performed, please click the link below.

David C. Mabrie, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 105 reviews

Twisted tip after rhinoplasty.

The fact that your nose looked good for "the first year or so" is testament to the fact that your surgeon did a good job of shaping the structural elements of the nose to give you the desired appearance. But, continued healing and scar formation has caused the cartilages that form the structure of your nose to collapse and buckle, which we see in a few patients who create more aggressive scarring than the "mythical average" patient.

This is not your fault, nor is it your surgeon's fault, but rather related to your own unique genetics of healing and scar formation in this area.

My best advice, see your surgeon and reassure him/her that you don't blame him/her for your present appearance, but really appreciate his/her expertise and input as to exact cause and recommended treatment for your present appearance. It may well be that additional surgery might be expected to yield a similar result and is therefore NOT recommended, or perhaps another option may be considered. If you had a result you liked for a year, I'd say "Trust your surgeon!"

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

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.