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

I believe there is a very poor quality work on your nose:
-you got aggresive alar cartilage reduction, leading to subtotal collapse of the nasal valve and pinched look
-then you received an aggressive transdomal suturing within a context of boxy tip, leading to your current tip issues
-but also you have bad grade of open roof deformity and inverted V (no osteotomies, back to school moment)

Indeed you need a full revision, some parts are damaged beyond repair or missing, like tip domes and lateral cruras respectively, it is likely you'll need new handmade elements (grafted from ear, septum, etc).

This is a case for a difficult, comprehensive but in good hands very rewarding revision rhinoplasty, do research well the surgeon's experience, talent and passion for fine work on difficult cases; do perform dozens of in person and online consultations before moving forward.

In the link associated to this answer you can find further information and images related to your problems.

Based on what we see, you appear to have relatively thin nasal skin, and they pointy tip appearance, along with relatively deep nasal creases, that are worse with smiling. If your goal would be to have a wider, and less operated nasal tip appearance, please consider microdroplet Silikon-1000 injections to smooth out your tip, and to add some volume which has disappeared, 6 years after your surgery. I hope this helps! Sincerely, Dr Joseph

Hello! Thank you for your question.
As far as I can understand from your question a well-planned revision rhinoplasty can correct cartilage shift, pinched tip, and asymmetry. These issues often result from weakened or overly resected cartilage. During revision, structural support can be restored using cartilage grafts (often from septum, ear, or rib) to improve both shape and breathing. Choose a surgeon experienced in complex revisions, as precise reconstruction of nasal framework is essential for lasting, natural results.
It would be better face to face consultation.
Best regards!

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