Cartilage shift/pinched tip - would a revision rhinoplasty fix this? (Photos)

I'd really love to see profile and 3/4 views, because those views would pin down better what's going on with the length of your nose, how *much* the tip droops. These frontal views give strong clues, but they're not best. The tip of the nose can be made less pinched, but if the nose is long-ish and that isn't addressed as a separate part of the operation, then the nose would probably look bigger and longer after work done only on the *width* of the tip, and not on its *position*. But yes, shortening the nose (and making it less forward-projecting if that is also an issue) is one of the more predictable changes to make to a nose, even in a revision, in expert hands.

How *much* to elevate the tip, or deproject the nose, or make other changes? We figure that out with morphs, well before surgery. 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 better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really 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 the surgeon has that information and judgment best.)

Finally, remember that revision rhinoplasty (or even a non-revision!) 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, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery.

Yes, much of the cartilage of your nose has been pinched together and can be substantially improved. A revision rhinoplasty should help with this considerably.

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include nasal tip deprojection, placement of a mastoid fascia tip graft for smoother tip contour, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon